Provider Demographics
NPI:1609034131
Name:TUBBS, VIRGINIA LOUISE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:LOUISE
Last Name:TUBBS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3981 SWINGLE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-4213
Mailing Address - Country:US
Mailing Address - Phone:307-237-2564
Mailing Address - Fax:
Practice Address - Street 1:428 S DURBIN ST STE 103
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2829
Practice Address - Country:US
Practice Address - Phone:307-265-2936
Practice Address - Fax:307-265-6575
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15067.0953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily