Provider Demographics
NPI:1760419980
Name:HUBBARD, LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 LAGRANDE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-2393
Mailing Address - Country:US
Mailing Address - Phone:352-430-0064
Mailing Address - Fax:352-430-0497
Practice Address - Street 1:314 LAGRANDE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-2393
Practice Address - Country:US
Practice Address - Phone:352-430-0064
Practice Address - Fax:352-430-0497
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115703363AM0700X, 363A00000X
PAMA058142363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9115703OtherFLORIDA LICENSE