Provider Demographics
NPI:1598927683
Name:BUBBICO, AMY L (CNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BUBBICO
Suffix:
Gender:F
Credentials:CNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:FOUR HUMOURS HEALTHCARE
Mailing Address - Street 2:4304 CARLISLE BLVD NE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4811
Mailing Address - Country:US
Mailing Address - Phone:505-888-1075
Mailing Address - Fax:505-888-1082
Practice Address - Street 1:FOUR HUMOURS HEALTHCARE
Practice Address - Street 2:4304 CARLISLE BLVD NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4811
Practice Address - Country:US
Practice Address - Phone:505-888-1075
Practice Address - Fax:505-888-1082
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMR28075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18702821Medicaid