Provider Demographics
NPI:1154852523
Name:TUGGLE, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:TUGGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4270 S DECATUR BLVD
Mailing Address - Street 2:STE B6
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6802
Mailing Address - Country:US
Mailing Address - Phone:702-485-2100
Mailing Address - Fax:702-825-0091
Practice Address - Street 1:1701 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2325
Practice Address - Country:US
Practice Address - Phone:702-671-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV212152084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program