Provider Demographics
NPI:1861618035
Name:HUDGENS, JEANNETTE LOUISE (MD)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:LOUISE
Last Name:HUDGENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 THE GROVE DR STE 280
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-8427
Mailing Address - Country:US
Mailing Address - Phone:407-704-7546
Mailing Address - Fax:321-400-1109
Practice Address - Street 1:4750 THE GROVE DR STE 280
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-8427
Practice Address - Country:US
Practice Address - Phone:407-704-7546
Practice Address - Fax:321-400-1109
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104883207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology