Provider Demographics
NPI:1780128298
Name:HODGES, REBECCA (ARNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HODGES
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 1:13910 LAKESHORE BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-1481
Mailing Address - Country:US
Mailing Address - Phone:727-862-5478
Mailing Address - Fax:
Practice Address - Street 1:13910 LAKESHORE BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1481
Practice Address - Country:US
Practice Address - Phone:727-862-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9269846363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology