1235150293 NPI number — FLORIDA DEPARTMENTOF CHILDREN AND FAMILIES

Table of content: ASHTON BREA HUGHES PA-C (NPI 1912277229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235150293 NPI number — FLORIDA DEPARTMENTOF CHILDREN AND FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA DEPARTMENTOF CHILDREN AND FAMILIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235150293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 WINEWOOD BLVD BLDG 2
Provider Second Line Business Mailing Address:
OFFICE OF REVENUE MANAGEMENT, ATTN: VELMA BRYANT
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32399-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-921-8749
Provider Business Mailing Address Fax Number:
954-392-3468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E CYPRESS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33025-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-392-3027
Provider Business Practice Location Address Fax Number:
954-392-3468
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FUNSTON
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
HOSP ADMIN
Authorized Official Telephone Number:
954-392-3050

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH16231 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1018109 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 026004500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018475300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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