Provider Demographics
NPI:1780116012
Name:ADDISON, HYACINTH FAY
Entity type:Individual
Prefix:
First Name:HYACINTH
Middle Name:FAY
Last Name:ADDISON
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 1:13944 BROADWING DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8122
Mailing Address - Country:US
Mailing Address - Phone:407-201-9051
Mailing Address - Fax:407-855-6819
Practice Address - Street 1:13944 BROADWING DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8122
Practice Address - Country:US
Practice Address - Phone:407-201-9051
Practice Address - Fax:407-855-6819
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9199382363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care