Healthcare Provider Details

I. General information

NPI: 1922701663
Provider Name (Legal Business Name): DRISTIN SHANE HUGHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

PO BOX 100277
GAINESVILLE FL
32610-0277
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0239
  • Fax:
Mailing address:
  • Phone: 352-265-0655
  • Fax: 352-265-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME180858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: