Healthcare Provider Details

I. General information

NPI: 1477001717
Provider Name (Legal Business Name): MICHAEL JARED HOBBS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 GILL ST
ALCOA TN
37701-2672
US

IV. Provider business mailing address

4995 S US HIGHWAY 1
FORT PIERCE FL
34982-7079
US

V. Phone/Fax

Practice location:
  • Phone: 865-982-3409
  • Fax: 865-977-9844
Mailing address:
  • Phone: 772-465-3225
  • Fax: 772-465-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6662
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: