Healthcare Provider Details

I. General information

NPI: 1235791906
Provider Name (Legal Business Name): MEREDITH HUTCHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SE TIFFANY AVE
PORT SAINT LUCIE FL
34952-7521
US

IV. Provider business mailing address

2644 SW REGENCY RD
STUART FL
34997-1223
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-4000
  • Fax:
Mailing address:
  • Phone: 703-328-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11002842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: