Provider Demographics
NPI:1518273317
Name:HUBBARD, TIANA DALERECA (ANP)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:DALERECA
Last Name:HUBBARD
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Gender:F
Credentials:ANP
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Mailing Address - Street 1:3450 W CHEYENNE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8223
Mailing Address - Country:US
Mailing Address - Phone:314-406-9081
Mailing Address - Fax:702-789-0717
Practice Address - Street 1:3450 W CHEYENNE AVE
Practice Address - Street 2:STE 200
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8223
Practice Address - Country:US
Practice Address - Phone:314-406-9081
Practice Address - Fax:702-789-0717
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2019-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN002430363LA2200X
MO2010027053363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health