Provider Demographics
NPI:1174712541
Name:HIBBS, MICHAEL DWAYNE (ARNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DWAYNE
Last Name:HIBBS
Suffix:
Gender:M
Credentials:ARNP
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Mailing Address - Street 1:2485 TINY TOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7219
Mailing Address - Country:US
Mailing Address - Phone:931-502-2423
Mailing Address - Fax:931-502-2370
Practice Address - Street 1:2485 TINY TOWN RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-7219
Practice Address - Country:US
Practice Address - Phone:931-502-2423
Practice Address - Fax:931-502-2370
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3322152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner