Provider Demographics
NPI:1174916183
Name:JUBERT, TINA (PA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:JUBERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:ROBESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3201
Mailing Address - Country:US
Mailing Address - Phone:585-368-6600
Mailing Address - Fax:585-368-6622
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-368-6600
Practice Address - Fax:585-368-6622
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018501363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical