Healthcare Provider Details

I. General information

NPI: 1346062494
Provider Name (Legal Business Name): CIARRA HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SCHOOL AVE
PATRICK SPACE FORCE BASE FL
32925
US

IV. Provider business mailing address

1150 STARLING WAY
ROCKLEDGE FL
32955-6347
US

V. Phone/Fax

Practice location:
  • Phone: 321-405-5500
  • Fax:
Mailing address:
  • Phone: 321-405-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: