Provider Demographics
NPI:1558868794
Name:AN, HYUNJUNG (ARNP)
Entity Type:Individual
Prefix:
First Name:HYUNJUNG
Middle Name:
Last Name:AN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:HYUNJUNG
Other - Middle Name:
Other - Last Name:AN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1324 LAKELAND HILLS BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:863-687-1305
Practice Address - Street 1:1324 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:863-687-1100
Practice Address - Fax:863-603-6534
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9363399363LG0600X
FLAG01180043363LP2300X
FLAPRN9363399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care