Provider Demographics
NPI:1942532403
Name:WARREN, HYDEE (MS)
Entity Type:Individual
Prefix:MS
First Name:HYDEE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8833 PERIMETER PARK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1111
Mailing Address - Country:US
Mailing Address - Phone:904-294-5329
Mailing Address - Fax:904-485-8460
Practice Address - Street 1:8833 PERIMETER PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-294-5329
Practice Address - Fax:904-485-8460
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013309657OtherNPI
FL011916900Medicaid
FL008665600Medicaid
FL012289300Medicaid
FL102214400Medicaid
FL1942532403OtherNP