Provider Demographics
NPI:1275916009
Name:HODGE, STEPHANYE
Entity Type:Individual
Prefix:MS
First Name:STEPHANYE
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 NW 16TH AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4050
Mailing Address - Country:US
Mailing Address - Phone:352-327-6069
Mailing Address - Fax:
Practice Address - Street 1:1324 NW 16TH AVE APT 23
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4050
Practice Address - Country:US
Practice Address - Phone:352-327-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL270759374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide