Provider Demographics
NPI:1821172990
Name:HODGE, DEBORAH ANN (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:HODGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16001 PARK TEN PL
Mailing Address - Street 2:STE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7885
Mailing Address - Country:US
Mailing Address - Phone:713-407-3000
Mailing Address - Fax:713-461-3476
Practice Address - Street 1:16001 PARK TEN PL
Practice Address - Street 2:STE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7885
Practice Address - Country:US
Practice Address - Phone:713-407-3000
Practice Address - Fax:713-461-3476
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX228086363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S79123Medicare UPIN
TX82N647Medicare ID - Type Unspecified