Individual provider Active NPI

Jennifer Hubbard

  • Registered Nurse
  • Randallstown, MD
National Provider Identifier
1043836885
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN269999 Issued in MD
Practice address
9854 Liberty Rd Ste E
Randallstown, MD 21133-2058
Phone
(443) 353-9729
NPI assigned
Jun 17, 2020
Last updated
Dec 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN269999 MD Primary

Addresses

Primary practice location

9854 Liberty Rd Ste E
Randallstown, MD 21133-2058

Mailing address

9854 Liberty Rd Ste E
Randallstown, MD 21133-2058
Phone (443) 353-9729

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RN269999MDMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Maryland Success Academy LLC Dba Maryland Success Lab LLC CurrentSince Mar 19, 2023 Accepting new patients
Maryland Success Academy LLC CurrentSince Aug 1, 2020 Accepting new patients

Locations

9854 Liberty Rd
Ste E
Randallstown, MD 21133
Phone (443) 353-9729

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1043836885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9854 LIBERTY RD STE E",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211332058",
            "telephone_number": "443-353-9729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9854 LIBERTY RD STE E",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211332058",
            "telephone_number": "443-353-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUBBARD",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-17",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MD",
            "license": "RN269999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Randallstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.