Healthcare Provider Details

I. General information

NPI: 1801229828
Provider Name (Legal Business Name): JESSICA LAUREN HODGES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10729 QUEENS TOWN DR
RIVERVIEW FL
33579-7186
US

IV. Provider business mailing address

720 BROOKER CREEK BLVD STE 215
OLDSMAR FL
34677-2937
US

V. Phone/Fax

Practice location:
  • Phone: 813-672-3497
  • Fax: 813-741-2418
Mailing address:
  • Phone: 501-256-2028
  • Fax: 813-436-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11048551
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR091928
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR091928
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: