Provider Demographics
NPI:1629304480
Name:HUDGINS DEDRICK, HALLIE LYNN (CLD,CHBE)
Entity Type:Individual
Prefix:MRS
First Name:HALLIE
Middle Name:LYNN
Last Name:HUDGINS DEDRICK
Suffix:
Gender:F
Credentials:CLD,CHBE
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:LYNN
Other - Last Name:DEDRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLD,CHBE
Mailing Address - Street 1:3089 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-1829
Mailing Address - Country:US
Mailing Address - Phone:727-743-6671
Mailing Address - Fax:
Practice Address - Street 1:3089 ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-1829
Practice Address - Country:US
Practice Address - Phone:727-743-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7577 (CAPPA)374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula