Provider Demographics
NPI:1811933096
Name:HUBBARD, JOSEPH JUAN (RN 71422)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JUAN
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:RN 71422
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2225
Mailing Address - Country:US
Mailing Address - Phone:803-432-5103
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC EVANS COMMUNITY HOSPITAL
Practice Address - Street 2:PACU SDS PADM
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-526-7015
Practice Address - Fax:719-526-7019
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN174865163W00000X
SC71422163W00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163W00000XNursing Service ProvidersRegistered Nurse