Healthcare Provider Details

I. General information

NPI: 1922652254
Provider Name (Legal Business Name): JUDY TUBMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDY HASKELL BRN

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8610 N NEW BRAUNFELS AVE
SAN ANTONIO TX
78217-6370
US

IV. Provider business mailing address

8610 N NEW BRAUNFELS AVE STE 405
SAN ANTONIO TX
78217-6358
US

V. Phone/Fax

Practice location:
  • Phone: 781-486-4116
  • Fax: 888-320-7507
Mailing address:
  • Phone: 781-486-4116
  • Fax: 888-320-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number954680
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: