Provider Demographics
NPI:1689841546
Name:HUDAK, PRISCILLA TEIXEIRA
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:TEIXEIRA
Last Name:HUDAK
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 1:2035 VALLEYGATE DR
Mailing Address - Street 2:STE. 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3984
Mailing Address - Country:US
Mailing Address - Phone:910-484-8009
Mailing Address - Fax:
Practice Address - Street 1:2035 VALLEYGATE DR
Practice Address - Street 2:STE. 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3984
Practice Address - Country:US
Practice Address - Phone:910-484-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant