Provider Demographics
NPI:1720094261
Name:TUBAUGH, LEIGH ANN (ANP-BC)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:TUBAUGH
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 GREYFRIAR CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6710
Mailing Address - Country:US
Mailing Address - Phone:704-779-6230
Mailing Address - Fax:
Practice Address - Street 1:280 SUNSET PARK DR STE 12
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5219
Practice Address - Country:US
Practice Address - Phone:704-779-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2452363LA2100X
NC5002184363LA2200X
VA0024183285363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
P64812Medicare UPIN