Provider Demographics
NPI:1992946883
Name:L & J HUSSEY ENTERPRISES, INC.
Entity type:Organization
Organization Name:L & J HUSSEY ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-482-2922
Mailing Address - Street 1:2161 LEON LN
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-7436
Mailing Address - Country:US
Mailing Address - Phone:850-482-2922
Mailing Address - Fax:850-482-8342
Practice Address - Street 1:2161 LEON LN
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-7436
Practice Address - Country:US
Practice Address - Phone:850-482-2922
Practice Address - Fax:850-482-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1231102363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ66528Medicare UPIN