Provider Demographics
NPI:1215439716
Name:TUBB, LARONDA (LVN)
Entity type:Individual
Prefix:
First Name:LARONDA
Middle Name:
Last Name:TUBB
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 DELAFIELD LN APT 2102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-4419
Mailing Address - Country:US
Mailing Address - Phone:870-315-2000
Mailing Address - Fax:
Practice Address - Street 1:4101 DELAFIELD LN APT 2102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-4419
Practice Address - Country:US
Practice Address - Phone:870-315-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334759164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse