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General NPI Number Information
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NPI Number | 1538377973
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Entity Type | Organization
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Legal Business Name | KRISTEN A. HUDACEK, PSY.D., PLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8019 N HIMES AVE SUITE 400
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City | TAMPA
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State | FL
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Zip | 33614-2712
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Country | US
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Telephone | 813-610-6007
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Fax |
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Provider Business Mailing Address
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Address Line | 5701 MARINER ST #402
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City | TAMPA
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State | FL
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Zip | 33609-3442
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Country | US
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Telephone | 813-610-6007
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRISTEN ANNE HUDACEK
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Credential | PSY.D.
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Telephone | 813-610-6007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY 7334
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License Number State | FL
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