Provider Demographics
NPI:1922652254
Name:TUBMAN, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:TUBMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:HASKELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BRN
Mailing Address - Street 1:8610 N NEW BRAUNFELS AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6358
Mailing Address - Country:US
Mailing Address - Phone:781-486-4116
Mailing Address - Fax:888-320-7507
Practice Address - Street 1:8610 N NEW BRAUNFELS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6370
Practice Address - Country:US
Practice Address - Phone:781-486-4116
Practice Address - Fax:888-320-7507
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX954680364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics