Provider Demographics
NPI:1336536960
Name:TUBAT, ERIC (DNP, PMHNP)
Entity Type:Individual
Prefix:PROF
First Name:ERIC
Middle Name:
Last Name:TUBAT
Suffix:
Gender:M
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10329 W MONTEBELLO AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85307-4313
Mailing Address - Country:US
Mailing Address - Phone:714-467-6281
Mailing Address - Fax:602-786-7796
Practice Address - Street 1:10329 W MONTEBELLO AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-4313
Practice Address - Country:US
Practice Address - Phone:714-467-6281
Practice Address - Fax:602-786-7796
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010580363LP0808X
390200000X
AZAP10517363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program