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General NPI Number Information
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NPI Number | 1689387888
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Entity Type | Individual
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Provider Name | JEFFREY TUBIOLO NP
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Gender | Male
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 10582 SE 32ND AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-6522
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Country | US
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Telephone | 503-344-6432
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Fax |
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Provider Business Mailing Address
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Address Line | 17437 BOONES FERRY RD STE 100
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-6202
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Country | US
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Telephone | 707-319-5068
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Fax |
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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 | 10003600
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License Number State | OR
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