Provider Demographics
NPI:1144566795
Name:HAMLIN, JUDITH FORD (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:FORD
Last Name:HAMLIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HARRISON ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3188
Mailing Address - Country:US
Mailing Address - Phone:315-464-6100
Mailing Address - Fax:315-464-9245
Practice Address - Street 1:550 HARRISON ST
Practice Address - Street 2:SUITE 117
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3188
Practice Address - Country:US
Practice Address - Phone:315-464-6100
Practice Address - Fax:315-464-9245
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336809-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03540741Medicaid
NYP01227412Medicare PIN
NYJ400087820Medicare PIN