Provider Demographics
NPI:1366991440
Name:HUDNALL, MARY JORDAN VENCILL (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JORDAN VENCILL
Last Name:HUDNALL
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:150 CLEARWATER LARGO RD N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2388
Mailing Address - Country:US
Mailing Address - Phone:727-518-0822
Mailing Address - Fax:727-518-6511
Practice Address - Street 1:150 CLEARWATER LARGO RD N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2388
Practice Address - Country:US
Practice Address - Phone:727-518-0822
Practice Address - Fax:727-518-6511
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2022-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9337786363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health