Provider Demographics
NPI:1194891044
Name:HUGHES, DEANNA ELMA (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:ELMA
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 HERSCHEL ST
Mailing Address - Street 2:STE 110
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2200
Mailing Address - Country:US
Mailing Address - Phone:904-504-5412
Mailing Address - Fax:904-374-3192
Practice Address - Street 1:4114 HERSCHEL ST
Practice Address - Street 2:STE 110
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2200
Practice Address - Country:US
Practice Address - Phone:904-504-5412
Practice Address - Fax:904-374-3192
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74068Medicare ID - Type UnspecifiedPSYCHOLOGIST