Provider Demographics
NPI:1518946763
Name:HUBBARD, MARIAMA PATRICIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIAMA
Middle Name:PATRICIA
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MARIAMA
Other - Middle Name:PATRICIA
Other - Last Name:YILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7 SIRE STAKES DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2879
Mailing Address - Country:US
Mailing Address - Phone:732-389-3889
Mailing Address - Fax:732-389-3889
Practice Address - Street 1:34 34TH ST UNIT 5A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2020
Practice Address - Country:US
Practice Address - Phone:917-453-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ000508000363LF0000X
NYF333990-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0046639Medicaid
NJ085606SU7Medicare PIN