Provider Demographics
NPI:1578249298
Name:HUDSON, MYNITA CHARIA
Entity Type:Individual
Prefix:
First Name:MYNITA
Middle Name:CHARIA
Last Name:HUDSON
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 1:196 SEVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-6671
Mailing Address - Country:US
Mailing Address - Phone:863-808-9089
Mailing Address - Fax:
Practice Address - Street 1:196 SEVEN OAKS DR
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-6671
Practice Address - Country:US
Practice Address - Phone:863-808-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93-2045228OtherDEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICE