Provider Demographics
NPI:1184910713
Name:CANNON, JUDY FAYE
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:FAYE
Last Name:CANNON
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 1:8640 SW 205TH CIR
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-5332
Mailing Address - Country:US
Mailing Address - Phone:352-322-1213
Mailing Address - Fax:352-522-8182
Practice Address - Street 1:8640 SW 205TH CIR
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-5332
Practice Address - Country:US
Practice Address - Phone:352-322-1213
Practice Address - Fax:352-522-8182
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3168642163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse