Provider Demographics
NPI:1760726061
Name:KUBAY, JACQUELYNN MARIE (ARNP,NP-C)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYNN
Middle Name:MARIE
Last Name:KUBAY
Suffix:
Gender:F
Credentials:ARNP,NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19149 MEADOWBROOK CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-6640
Mailing Address - Country:US
Mailing Address - Phone:407-469-2749
Mailing Address - Fax:
Practice Address - Street 1:12700 CREEKSIDE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3356
Practice Address - Country:US
Practice Address - Phone:407-797-8208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL714372363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health