Provider Demographics
NPI:1679846117
Name:HUBBARD-DAVIS, JENNIFER M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HUBBARD-DAVIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 IRON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1628
Mailing Address - Country:US
Mailing Address - Phone:804-318-5589
Mailing Address - Fax:
Practice Address - Street 1:10800 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1628
Practice Address - Country:US
Practice Address - Phone:804-318-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009379363LF0000X
VA0024171048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN