MEDICARE: LATOYA RENEE HUGULEY APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	APRN003387	GA
2	207Q00000X	Family Medicine Physician	APRN11010210	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP003387	OTHER	GA	APRN GAA NP

General Provider Information

NPI Number	:	1356015192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA RENEE HUGULEY APRN

Provider Business Mailing Address
First Line	:	9428 BAYMEADOWS RD STE 502
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7973
Country	:	US
Telephone Number	:	904-837-7623
Fax Number	:	904-902-0768

Provider Business Practice Location Address
First Line	:	9428 BAYMEADOWS RD STE 502
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7973
Country	:	US
Telephone Number	:	904-902-0736
Fax Number	:	904-902-0768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	03/23/2026

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