Organization Active NPI

Tldubose LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Grayslake, IL
National Provider Identifier
1790664647
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
TLDUBOSE LLC
Practice address
17707 W Dartmoor Dr
Grayslake, IL 60030-1996
Phone
(401) 602-3938
NPI assigned
Aug 27, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tammy Dubose, BC-PMHNP, APRNNPI 1437494630
Title
Psychiatric Nurse Practitioner
Phone
(401) 602-3938

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

17707 W Dartmoor Dr
Grayslake, IL 60030-1996

Mailing address

17707 W Dartmoor Dr
Grayslake, IL 60030-1996
Phone (401) 602-3938

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1756252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756252800000",
    "number": "1790664647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17707 W DARTMOOR DR",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600301996",
            "telephone_number": "401-602-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17707 W DARTMOOR DR",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600301996",
            "telephone_number": "401-602-3938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLDUBOSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-27",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A",
        "authorized_official_last_name": "DUBOSE",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "PSYCHIATRIC NURSE PRACTITIONER",
        "authorized_official_telephone_number": "401-602-3938",
        "authorized_official_credential": "BC-PMHNP, APRN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayslake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.