Timothy Lewis Hubbard

Primary specialty

Registered Nurse First AssistantTaxonomy code 163WR0006X

License

4704271120 Issued in MI

Practice address

851 Deer Run Lake Rd
Holly, MI 48442-1570

Phone

(810) 358-5636

NPI assigned

Dec 6, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1575590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575590400000",
    "number": "1699312843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 DEER RUN LAKE RD",
            "city": "HOLLY",
            "state": "MI",
            "postal_code": "484421570",
            "telephone_number": "810-358-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 DEER RUN LAKE RD",
            "city": "HOLLY",
            "state": "MI",
            "postal_code": "484421570",
            "telephone_number": "810-358-5636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUBBARD",
        "first_name": "TIMOTHY",
        "middle_name": "LEWIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-06",
        "last_updated": "2019-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "MI",
            "license": "4704271120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Pharmacy LLC
• Holly Urgent Care PLLC
• Holly Vision Clinic PC
• Holly Vision Source
• Hannah Leigh Houtz
• Marie Elizabeth Hunter, D.D.S.
• Randy Lynn Hunter, D.D.S.
• Alexzandrea Israel, DOULA
• Amy Jacobs
• Jill Jenks, LMT

• All providers in Holly, MI
• Registered Nurse First Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; 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.