Provider Demographics
NPI:1720490329
Name:HUDSON, NELSY E (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:NELSY
Middle Name:E
Last Name:HUDSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 MINERVA LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6410
Mailing Address - Country:US
Mailing Address - Phone:321-527-0913
Mailing Address - Fax:
Practice Address - Street 1:985 STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5664
Practice Address - Country:US
Practice Address - Phone:407-831-5252
Practice Address - Fax:407-831-3765
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9177916363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012459500Medicaid