Provider Demographics
NPI:1780243238
Name:HUDSON, VIVIETTE (MSHCM)
Entity type:Individual
Prefix:
First Name:VIVIETTE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MSHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 AVALON PARK EAST BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4902
Mailing Address - Country:US
Mailing Address - Phone:407-205-2415
Mailing Address - Fax:
Practice Address - Street 1:2393 BLAKE WAY
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-8675
Practice Address - Country:US
Practice Address - Phone:407-205-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9636300163W00000X
171M00000X, 174N00000X, 253Z00000X, 374J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No253Z00000XAgenciesIn Home Supportive Care
No374J00000XNursing Service Related ProvidersDoula