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General NPI Number Information
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NPI Number | 1356837025
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Entity Type | Individual
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Provider Name | AMY TUBRE APRN
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Gender | Female
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 6823 ISAACS ORCHARD RD
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City | SPRINGDALE
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State | AR
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Zip | 72762-6096
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Country | US
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Telephone | 479-750-2080
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Fax | 479-750-2082
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Provider Business Mailing Address
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Address Line | PO BOX 100174
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City | COLUMBIA
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State | SC
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Zip | 29202-3174
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Country | US
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Telephone | 864-224-0822
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Fax | 864-375-0196
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10121
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F06182133
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License Number State | SC
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