Provider Demographics
NPI:1235784117
Name:BUCHANAN, JUDY (APRN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:BUCHANAN HARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 HILDA ST STE 26
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2359
Mailing Address - Country:US
Mailing Address - Phone:407-944-3071
Mailing Address - Fax:
Practice Address - Street 1:201 HILDA ST STE 26
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2359
Practice Address - Country:US
Practice Address - Phone:407-944-3071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMS332OtherMEDICARE