Provider Demographics
NPI:1316101470
Name:HUTTON, HYACINTH VIOLA (PERSONALCARE ASST)
Entity type:Individual
Prefix:
First Name:HYACINTH
Middle Name:VIOLA
Last Name:HUTTON
Suffix:
Gender:F
Credentials:PERSONALCARE ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 NW 46TH AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7171
Mailing Address - Country:US
Mailing Address - Phone:954-258-1814
Mailing Address - Fax:
Practice Address - Street 1:1631 NW 46TH AVE
Practice Address - Street 2:114
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-7171
Practice Address - Country:US
Practice Address - Phone:954-258-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6802290963747P1801X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680229096OtherMEDWAIVER