Provider Demographics
NPI:1407698848
Name:HODULIK, SYDNEE PAIGE
Entity type:Individual
Prefix:
First Name:SYDNEE
Middle Name:PAIGE
Last Name:HODULIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYDNEE
Other - Middle Name:PAIGE
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6260
Mailing Address - Fax:239-343-6259
Practice Address - Street 1:9981 S HEALTHPARK DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3618
Practice Address - Country:US
Practice Address - Phone:239-343-6260
Practice Address - Fax:239-343-6259
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9488705163W00000X
FLAPRN11033630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123052600Medicaid