Provider Demographics
NPI:1093945594
Name:STADDON, LUDMYLA J (ARNP)
Entity Type:Individual
Prefix:
First Name:LUDMYLA
Middle Name:J
Last Name:STADDON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2510
Mailing Address - Country:US
Mailing Address - Phone:863-644-2411
Mailing Address - Fax:863-648-4969
Practice Address - Street 1:5010 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2510
Practice Address - Country:US
Practice Address - Phone:863-644-2411
Practice Address - Fax:863-648-4969
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9245779363LF0000X
FLRN9245779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily