MEDICARE: MRS. JOVAWNA DAWN ELLISON-HUBBARD MSN,APRN,FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	690673	TX

General Provider Information

NPI Number	:	1720276843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOVAWNA DAWN ELLISON-HUBBARD MSN,APRN,FNP-BC

Provider Business Mailing Address
First Line	:	205 W WINDCREST ST
Second Line	:	STE 130
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4478
Country	:	US
Telephone Number	:	830-833-5581
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 S US HIGHWAY 281
Second Line	:	STE 101 C
City	:	JOHNSON CITY
State	:	TX
Zip	:	78636-4950
Country	:	US
Telephone Number	:	830-868-7800
Fax Number	:	830-992-2861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	08/09/2023

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