Provider Demographics
NPI:1902142698
Name:HUGHES, JACQUANA BERNADETTE
Entity Type:Individual
Prefix:MS
First Name:JACQUANA
Middle Name:BERNADETTE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-5029
Mailing Address - Country:US
Mailing Address - Phone:904-372-1392
Mailing Address - Fax:904-647-1936
Practice Address - Street 1:5200 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5029
Practice Address - Country:US
Practice Address - Phone:904-372-1392
Practice Address - Fax:904-647-1936
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004722400Medicaid