Provider Demographics
NPI:1639734254
Name:HUBBARD, ANDREA M
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:M
Last Name:HUBBARD
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 1:1636 POPPS FERRY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2276
Mailing Address - Country:US
Mailing Address - Phone:228-383-6241
Mailing Address - Fax:228-392-6963
Practice Address - Street 1:1636 POPPS FERRY RD STE 110
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2276
Practice Address - Country:US
Practice Address - Phone:228-383-6241
Practice Address - Fax:228-392-6963
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker