Provider Demographics
NPI:1336504513
Name:HODGES, LAMONICA ANTONETTE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAMONICA
Middle Name:ANTONETTE
Last Name:HODGES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LAMONICA
Other - Middle Name:ANTONETTE
Other - Last Name:HODGES-HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:6040 N CAMELBACK MANOR DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5148
Mailing Address - Country:US
Mailing Address - Phone:928-606-8705
Mailing Address - Fax:866-841-2587
Practice Address - Street 1:6040 N CAMELBACK MANOR DR
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5148
Practice Address - Country:US
Practice Address - Phone:784-532-9222
Practice Address - Fax:866-841-2587
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901388363LF0000X
AZ242329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09551264Medicaid
MS481815ZTZSMedicare UPIN
MS481845ZU70Medicare UPIN