Provider Demographics
NPI:1548916356
Name:EDMILAO, ELEANOR EUNICE TUBAT
Entity type:Individual
Prefix:DR
First Name:ELEANOR EUNICE
Middle Name:TUBAT
Last Name:EDMILAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7553 N SUMMIT PASS
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86315-4598
Mailing Address - Country:US
Mailing Address - Phone:602-531-1059
Mailing Address - Fax:
Practice Address - Street 1:7553 N SUMMIT PASS
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-4598
Practice Address - Country:US
Practice Address - Phone:602-531-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ270856363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health