MEDICARE: MRS. GINA HODGES LPN

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	164W00000X	Licensed Practical Nurse	PN5230226	FL

General Provider Information

NPI Number	:	1942196456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA HODGES LPN

Provider Business Mailing Address
First Line	:	1923 KINGSLEE DR
Second Line	:
City	:	SOUTHPORT
State	:	FL
Zip	:	32409-3563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1923 KINGSLEE DR
Second Line	:
City	:	SOUTHPORT
State	:	FL
Zip	:	32409-3563
Country	:	US
Telephone Number	:	850-624-0321
Fax Number	:

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

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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