Provider Demographics
NPI:1962910760
Name:DUBRAVCIC, PHILLIP CASEY (PMHNP)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:CASEY
Last Name:DUBRAVCIC
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 W UNIVERSITY AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2603
Mailing Address - Country:US
Mailing Address - Phone:928-248-8082
Mailing Address - Fax:855-930-4003
Practice Address - Street 1:906 W UNIVERSITY AVE STE 150
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2603
Practice Address - Country:US
Practice Address - Phone:928-248-8082
Practice Address - Fax:855-930-4003
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10899363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health