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Individual provider Active NPI

Jacqueline Susan Hudson, ARNP

  • Family Nurse Practitioner
  • Orlando, FL
National Provider Identifier
1114074978
Registry record updated Sep 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9173487 Issued in FL
Practice address
7300 Sandlake Commons Blvd Ste 221
Orlando, FL 32819-8011
Phone
(407) 284-3552
Fax
(407) 284-3553
NPI assigned
Jan 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9173487 FL Primary

Addresses

Primary practice location

7300 Sandlake Commons Blvd Ste 221
Orlando, FL 32819-8011

Mailing address

7300 Sandlake Commons Blvd Ste 221
Orlando, FL 32819-8011
Phone (407) 284-3552

Other identifiers 4

IdentifierTypeStateIssuer
004505100MedicaidFL
Y03U7OtherFLBC/BS PROVIDER#
ARNP9173487OtherFLLICENSE NUMBER
P01202534OtherFLRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100111000222 FL Practitioner - Nurse Practitioner 9931240124 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
My Endocrinologist PAGroup PAC ID 8022290956, 5 clinicians

Practice addresses (Care Compare)

213 S Dillard St
Suite 240
Winter Garden, FL 34787-3596
Phone (407) 409-8067

Hospital & facility affiliations

  • Orlando Health South Lake Hospital Hospital, Clermont, FL, CCN 100051
  • Orlando Health-Health Central Hospital Hospital, Ocoee, FL, CCN 100030
  • Adventhealth Waterman Hospital, Tavares, FL, CCN 100057
  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007
  • Orlando Health Hospital, Orlando, FL, CCN 100006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9173487FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
My Endocrinologist PA CurrentSince Mar 1, 2020 Accepting new patients
Sand Lake Internal Medicine, LLC CurrentSince Sep 25, 2019 Accepting new patients

Locations

7300 Sandlake Commons Blvd
Ste 221
Orlando, FL 32819
Phone (407) 284-3552

213 S Dillard St
Ste 240
Winter Garden, FL 34787
Phone (407) 409-8067

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1114074978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 SANDLAKE COMMONS BLVD STE 221",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198011",
            "telephone_number": "407-284-3552",
            "fax_number": "407-284-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 SANDLAKE COMMONS BLVD STE 221",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328198011",
            "telephone_number": "407-284-3552",
            "fax_number": "407-284-3553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "JACQUELINE",
        "middle_name": "SUSAN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9173487",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004505100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER#",
            "identifier": "Y03U7",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "ARNP9173487",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01202534",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.