Provider Demographics
NPI:1215924865
Name:HIBEL, JUDITH ANNE (NP)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANNE
Last Name:HIBEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3598
Mailing Address - Country:US
Mailing Address - Phone:561-863-0105
Mailing Address - Fax:561-863-6779
Practice Address - Street 1:500 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-3598
Practice Address - Country:US
Practice Address - Phone:561-863-0105
Practice Address - Fax:561-863-6779
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1207462363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303557300Medicaid