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General NPI Number Information
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NPI Number | 1720960040
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Entity Type | Individual
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Provider Name | ETHAN HUGHES MT-BC
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Gender | Male
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 12276 SAN JOSE BLVD STE 508
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8618
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Country | US
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Telephone | 904-886-3228
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Fax | 904-485-8876
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Provider Business Mailing Address
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Address Line | 12276 SAN JOSE BLVD STE 508
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8618
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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