Provider Demographics
NPI:1346954336
Name:TUBBS, LORI ANN (RDN)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:TUBBS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 BREAKERS CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1240
Mailing Address - Country:US
Mailing Address - Phone:757-630-3332
Mailing Address - Fax:
Practice Address - Street 1:1300 HELICOPTER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-8913
Practice Address - Country:US
Practice Address - Phone:757-763-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA846670133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered