Healthcare Provider Details

I. General information

NPI: 1538947288
Provider Name (Legal Business Name): LUCIE GEDEUM-HIPPOLYTE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SIMPSON RD
KISSIMMEE FL
34744-4637
US

IV. Provider business mailing address

1042 BERRY LN
DAVENPORT FL
33837-8631
US

V. Phone/Fax

Practice location:
  • Phone: 407-632-4217
  • Fax: 407-632-4226
Mailing address:
  • Phone: 561-633-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11028201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: