Provider Demographics
NPI:1588744007
Name:BUBEN, TAMEKA (NP)
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:BUBEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 HARBOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-9031
Mailing Address - Country:US
Mailing Address - Phone:901-626-7757
Mailing Address - Fax:
Practice Address - Street 1:8580 CINDERBED ROAD
Practice Address - Street 2:SUITE 1700
Practice Address - City:NEWINGTON
Practice Address - State:VA
Practice Address - Zip Code:22122
Practice Address - Country:US
Practice Address - Phone:703-550-8145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner