Provider Demographics
NPI:1538947288
Name:GEDEUM-HIPPOLYTE, LUCIE (APRN)
Entity type:Individual
Prefix:
First Name:LUCIE
Middle Name:
Last Name:GEDEUM-HIPPOLYTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 BERRY LN
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8631
Mailing Address - Country:US
Mailing Address - Phone:561-633-7883
Mailing Address - Fax:
Practice Address - Street 1:2550 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4637
Practice Address - Country:US
Practice Address - Phone:407-632-4217
Practice Address - Fax:407-632-4226
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty