Provider Demographics
NPI:1184062713
Name:HUBBLE, JERRILEA A (FNP-C; RNFA)
Entity type:Individual
Prefix:
First Name:JERRILEA
Middle Name:A
Last Name:HUBBLE
Suffix:
Gender:F
Credentials:FNP-C; RNFA
Other - Prefix:
Other - First Name:JERRILEA
Other - Middle Name:A
Other - Last Name:HUBBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP, RNFA
Mailing Address - Street 1:800 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4611
Mailing Address - Country:US
Mailing Address - Phone:817-759-7000
Mailing Address - Fax:817-759-7027
Practice Address - Street 1:515 W MAYFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2084
Practice Address - Country:US
Practice Address - Phone:817-759-7000
Practice Address - Fax:817-759-7027
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX752938163WR0006X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant