Provider Demographics
NPI:1487802054
Name:WUBBENA, TROY A (PA-C, PHD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:WUBBENA
Suffix:
Gender:M
Credentials:PA-C, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8451 SHADE AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2878
Mailing Address - Country:US
Mailing Address - Phone:941-360-1030
Mailing Address - Fax:941-360-1202
Practice Address - Street 1:8451 SHADE AVE
Practice Address - Street 2:STE 108
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2878
Practice Address - Country:US
Practice Address - Phone:941-360-1030
Practice Address - Fax:941-360-1202
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104389363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical