Provider Demographics
NPI:1811581051
Name:JUBB, SUZANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:JUBB
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 1:102 S. THIRD ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-6321
Mailing Address - Fax:989-584-6773
Practice Address - Street 1:102 S. THIRD ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811
Practice Address - Country:US
Practice Address - Phone:989-584-6321
Practice Address - Fax:989-584-6773
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010226363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical