Healthcare Provider Details

I. General information

NPI: 1568404002
Provider Name (Legal Business Name): MARIA GRACIA TOLENTINO HUDSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACIA TOLENTINO HUDSON

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CENTER ST
GULF BREEZE FL
32561-4392
US

IV. Provider business mailing address

204 CENTER ST
GULF BREEZE FL
32561-4392
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-2597
  • Fax: 866-939-1533
Mailing address:
  • Phone: 850-477-2597
  • Fax: 866-939-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00029
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18149
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: