Provider Demographics
NPI:1063682060
Name:HUBBARD, SANDRA F (CANP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:F
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 GAUSE BLVD E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4141
Mailing Address - Country:US
Mailing Address - Phone:985-641-7283
Mailing Address - Fax:985-641-7218
Practice Address - Street 1:2360 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4141
Practice Address - Country:US
Practice Address - Phone:985-641-7283
Practice Address - Fax:985-641-7218
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05326363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2424599Medicaid