Provider Demographics
NPI:1851539373
Name:LOON, JUDY ARCHER (APRN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ARCHER
Last Name:LOON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOSPITAL CENTER BLVD
Mailing Address - Street 2:STE. 104, MEDICAL PAVILION
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2738
Mailing Address - Country:US
Mailing Address - Phone:843-681-5879
Mailing Address - Fax:843-681-2168
Practice Address - Street 1:25 HOSPITAL CENTER BLVD
Practice Address - Street 2:STE. 104, MEDICAL PAVILION
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2738
Practice Address - Country:US
Practice Address - Phone:843-681-5879
Practice Address - Fax:843-681-2168
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3808363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health