Provider Demographics
NPI:1285188946
Name:HUBBARD, ELLYSON JAMEL (APRN)
Entity type:Individual
Prefix:
First Name:ELLYSON
Middle Name:JAMEL
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 LEE RD STE 165
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2127
Mailing Address - Country:US
Mailing Address - Phone:407-821-3547
Mailing Address - Fax:407-821-3548
Practice Address - Street 1:1801 LEE RD STE 165
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2127
Practice Address - Country:US
Practice Address - Phone:407-821-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11042888363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health