Healthcare Provider Details

I. General information

NPI: 1093241663
Provider Name (Legal Business Name): AMABEL TANGUNAN LUBATON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 STATE ROAD 436 STE 224
CASSELBERRY FL
32707-4965
US

IV. Provider business mailing address

430 STATE ROAD 436 STE 224
CASSELBERRY FL
32707-4965
US

V. Phone/Fax

Practice location:
  • Phone: 786-449-5448
  • Fax:
Mailing address:
  • Phone: 786-449-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9261848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: