Provider Demographics
NPI:1942833041
Name:LUCA, TABITHA DOBREI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:DOBREI
Last Name:LUCA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 DE ETTA DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1638
Mailing Address - Country:US
Mailing Address - Phone:248-819-2513
Mailing Address - Fax:
Practice Address - Street 1:12150 30 MILE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48095-2035
Practice Address - Country:US
Practice Address - Phone:586-753-7256
Practice Address - Fax:586-331-2323
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704306783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily