Provider Demographics
NPI:1992038426
Name:HUBICKI, JOHN A (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:HUBICKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 TAMIAMI TRL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8046
Mailing Address - Country:US
Mailing Address - Phone:941-629-3000
Mailing Address - Fax:941-629-6711
Practice Address - Street 1:3109 TAMIAMI TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8046
Practice Address - Country:US
Practice Address - Phone:941-629-3000
Practice Address - Fax:941-629-6711
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical