Healthcare Provider Details

I. General information

NPI: 1538083522
Provider Name (Legal Business Name): ANDREW MICHAEL HUDSON FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 LAKELAND PARK CENTER DR
LAKELAND FL
33809-3841
US

IV. Provider business mailing address

919 LAKELAND PARK CENTER DR
LAKELAND FL
33809-3841
US

V. Phone/Fax

Practice location:
  • Phone: 863-316-3900
  • Fax: 863-316-3910
Mailing address:
  • Phone: 863-316-3900
  • Fax: 863-316-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: