Provider Demographics
NPI:1285600502
Name:HUDON, TIA B (APN)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:B
Last Name:HUDON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W LONGACRES DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7914
Mailing Address - Country:US
Mailing Address - Phone:702-487-7055
Mailing Address - Fax:
Practice Address - Street 1:2225 E FLAMINGO RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5126
Practice Address - Country:US
Practice Address - Phone:702-877-8625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000747363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500741Medicaid
NVP00091698OtherRAILROAD MEDICARE
NVP00091698OtherRAILROAD MEDICARE
P18616Medicare UPIN