Healthcare Provider Details

I. General information

NPI: 1720369424
Provider Name (Legal Business Name): ANTHONY JOHN HUDSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E FOWLER AVE STE 100
TEMPLE TERRACE FL
33617-2305
US

IV. Provider business mailing address

5901 E FOWLER AVE STE 100
TEMPLE TERRACE FL
33617-2305
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9700
  • Fax: 813-558-6187
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-558-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9106143
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9106143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: