Individual
DEIDRA DARE HUCKABEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
295 MIDLAND PKWY, SUMMERVILLE, SC 29485-8104
(843) 832-5000
Mailing address
5870 HIATUS RD, TAMARAC, FL 33321-6424
(954) 377-2939
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
77786
SC
Other
Enumeration date
09/28/2018
Last updated
10/01/2018
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