Provider Demographics
NPI:1336693324
Name:TUBBS, LAURA NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:TUBBS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 S VAL VISTA DR STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3139
Mailing Address - Country:US
Mailing Address - Phone:480-497-2900
Mailing Address - Fax:480-497-2906
Practice Address - Street 1:754 S VAL VISTA DR STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3139
Practice Address - Country:US
Practice Address - Phone:480-497-2900
Practice Address - Fax:480-497-2906
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95070496163W00000X
CA95012408363LA2200X
AZ287406363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health