MEDICARE: JACQUELINE SUSAN HUDSON ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9173487	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P01202534	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y03U7	OTHER	FL	BC/BS PROVIDER#
3	ARNP9173487	OTHER	FL	LICENSE NUMBER

General Provider Information

NPI Number	:	1114074978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SUSAN HUDSON ARNP

Provider Business Mailing Address
First Line	:	7300 SANDLAKE COMMONS BLVD STE 221
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8011
Country	:	US
Telephone Number	:	407-284-3552
Fax Number	:	407-284-3553

Provider Business Practice Location Address
First Line	:	7300 SANDLAKE COMMONS BLVD STE 221
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8011
Country	:	US
Telephone Number	:	407-284-3552
Fax Number	:	407-284-3553

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	09/17/2019

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