Provider Demographics
NPI:1689300691
Name:TEBBS, STEVEN BRENT (PA-C)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRENT
Last Name:TEBBS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 E BELL ROCK TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-0016
Mailing Address - Country:US
Mailing Address - Phone:801-404-8212
Mailing Address - Fax:
Practice Address - Street 1:6612 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2119
Practice Address - Country:US
Practice Address - Phone:520-207-1585
Practice Address - Fax:520-616-2656
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ94402084P0800X, 2084P0800X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical