Individual
DEBORAH HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4001 KALUGA PARK ST, ORLANDO, FL 32808-7473
(407) 982-6629
Mailing address
4001 KALUGA PARK ST, ORLANDO, FL 32808-7473
(407) 982-6629
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
7G331A/C
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6841970001
MEDWAIVER
FL
01
—
684197096
MEDWAIVER
FL
01
—
684197098
MEDWAIVER
FL
Enumeration date
01/31/2014
Last updated
01/31/2014
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