Provider Demographics
NPI:1740425479
Name:HUBBARD, MANDY D BRINSON (FNP)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:D BRINSON
Last Name:HUBBARD
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SE BROAD ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31546-4628
Mailing Address - Country:US
Mailing Address - Phone:912-559-2710
Mailing Address - Fax:
Practice Address - Street 1:191 SE BROAD ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31546-4628
Practice Address - Country:US
Practice Address - Phone:912-223-5970
Practice Address - Fax:912-530-7339
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169681363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily