Provider Demographics
NPI:1598715633
Name:TUBBS, ERICA S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:S
Last Name:TUBBS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:NE
Mailing Address - Zip Code:68780-0070
Mailing Address - Country:US
Mailing Address - Phone:402-924-3777
Mailing Address - Fax:402-924-3776
Practice Address - Street 1:110 W. 2ND ST.
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:NE
Practice Address - Zip Code:68780-0070
Practice Address - Country:US
Practice Address - Phone:402-924-3777
Practice Address - Fax:402-924-3776
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE507046435Medicaid
NE39168OtherBCBS
NE246574OtherMIDLANDS CHOICE
NE281755Medicare PIN
Q42558Medicare UPIN