Provider Demographics
NPI:1346322443
Name:HINES, JUDY LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:LYNN
Last Name:HINES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 NONASTONE RUN
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5846
Mailing Address - Country:US
Mailing Address - Phone:407-864-0392
Mailing Address - Fax:
Practice Address - Street 1:2984 ALAFAYA TRL
Practice Address - Street 2:SUITE 2000
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7628
Practice Address - Country:US
Practice Address - Phone:407-366-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG18744Medicare UPIN