Provider Demographics
NPI:1720276843
Name:ELLISON-HUBBARD, JOVAWNA DAWN (MSN,APRN,FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JOVAWNA
Middle Name:DAWN
Last Name:ELLISON-HUBBARD
Suffix:
Gender:F
Credentials:MSN,APRN,FNP-BC
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Mailing Address - Street 1:205 W WINDCREST ST
Mailing Address - Street 2:STE 130
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4478
Mailing Address - Country:US
Mailing Address - Phone:830-833-5581
Mailing Address - Fax:
Practice Address - Street 1:405 S US HIGHWAY 281
Practice Address - Street 2:STE 101 C
Practice Address - City:JOHNSON CITY
Practice Address - State:TX
Practice Address - Zip Code:78636-4950
Practice Address - Country:US
Practice Address - Phone:830-868-7800
Practice Address - Fax:830-992-2861
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2023-08-09
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Provider Licenses
StateLicense IDTaxonomies
TX690673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX481872YNQ4Medicare PIN