Provider Demographics
NPI:1619638509
Name:HUBBARD, MICHAELA ROWLAND (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ROWLAND
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:ROWLAND
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:ONE GI CREDENTIALING DEPARTMENT
Mailing Address - Street 2:PO BOX 381468
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-6300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:661 INDEPENDENCE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5114
Practice Address - Country:US
Practice Address - Phone:757-547-0798
Practice Address - Fax:757-547-0145
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008722363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant