Provider Demographics
NPI:1912957556
Name:HUBBARD, HELENE RABENA (MD)
Entity type:Individual
Prefix:DR
First Name:HELENE
Middle Name:RABENA
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HELENE
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6040 STATE ROAD 70 E UNIT B
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9720
Mailing Address - Country:US
Mailing Address - Phone:941-366-2273
Mailing Address - Fax:941-953-6500
Practice Address - Street 1:6040 STATE ROAD 70 E UNIT B
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9720
Practice Address - Country:US
Practice Address - Phone:941-366-2273
Practice Address - Fax:941-953-6500
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME544302080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250144900Medicaid
FLG10756Medicare UPIN