Provider Demographics
NPI:1114074978
Name:HUDSON, JACQUELINE SUSAN (ARNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUSAN
Last Name:HUDSON
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 1:7300 SANDLAKE COMMONS BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8011
Mailing Address - Country:US
Mailing Address - Phone:407-284-3552
Mailing Address - Fax:407-284-3553
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD STE 221
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8011
Practice Address - Country:US
Practice Address - Phone:407-284-3552
Practice Address - Fax:407-284-3553
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9173487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004505100Medicaid
FLY03U7OtherBC/BS PROVIDER#
FLARNP9173487OtherLICENSE NUMBER
FLP01202534OtherRAILROAD MEDICARE
FL004505100Medicaid