Provider Demographics
NPI:1245752658
Name:ECKERD, JUDITH ANN (RN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:ECKERD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 RUSSIAN OLIVE LN
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4661
Mailing Address - Country:US
Mailing Address - Phone:813-780-7755
Mailing Address - Fax:
Practice Address - Street 1:3806 RUSSIAN OLIVE LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4661
Practice Address - Country:US
Practice Address - Phone:813-780-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9368885163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9368885OtherRN LICENSE