Provider Demographics
NPI:1205818838
Name:HUDDLESTON, DEBORAH L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:WALCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:601 OAK COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4213
Mailing Address - Country:US
Mailing Address - Phone:407-846-0626
Mailing Address - Fax:407-846-2524
Practice Address - Street 1:601 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4213
Practice Address - Country:US
Practice Address - Phone:407-846-0626
Practice Address - Fax:407-846-2524
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1690172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS77512Medicare UPIN
FLS77512Medicare UPIN