Provider Demographics
NPI:1093043937
Name:DAVIS HODNETT, ESTELLE JANE (NP, ARNP)
Entity Type:Individual
Prefix:MS
First Name:ESTELLE
Middle Name:JANE
Last Name:DAVIS HODNETT
Suffix:
Gender:F
Credentials:NP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BAY POINT WAY NORTH
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7907
Mailing Address - Country:US
Mailing Address - Phone:904-687-3677
Mailing Address - Fax:904-230-6969
Practice Address - Street 1:4051 PHILIPS HIGHWAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-7299
Practice Address - Country:US
Practice Address - Phone:904-737-5220
Practice Address - Fax:904-448-6794
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL783732363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health