=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467059790
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. MIKALA PATRICIA HUGHES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2020
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5821 S WILLIAMSON BLVD STE 204
-----------------------------------------------------
City | PORT ORANGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32128-6102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-231-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5821 S WILLIAMSON BLVD STE 204
-----------------------------------------------------
City | PORT ORANGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32128-6102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-231-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN11008643
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------