Provider Demographics
NPI:1700870177
Name:HUGGARD, DONALD J (PA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:HUGGARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5616
Mailing Address - Country:US
Mailing Address - Phone:386-871-5708
Mailing Address - Fax:
Practice Address - Street 1:812 W INDIAN BLVD.
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-3429
Practice Address - Country:US
Practice Address - Phone:386-426-1411
Practice Address - Fax:386-426-1411
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001658OtherFLORIDA HEALTH CARE
FLIB111ZOtherMEDICARE PTAN
FLE0648Medicare PIN
FL0513070001Medicare NSC
FL001658OtherFLORIDA HEALTH CARE