Active NPI
Latressa J Fudge, MSW
- Social Worker
- Orlando, FL
National Provider Identifier
1386993780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 1010 Executive Center Dr
Orlando, FL 32803-3529 - Phone
- (407) 920-3321
- NPI assigned
- Aug 31, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary |
Addresses
Primary practice location
1010 Executive Center Dr
Orlando, FL 32803-3529
Mailing address
1010 Executive Center Drive
Orlando, FL 32803
Phone (407) 920-3321
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 10, 2024 through Feb 10, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346371200000",
"number": "1386993780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 EXECUTIVE CENTER DRIVE",
"city": "ORLANDO",
"state": "FL",
"postal_code": "32803",
"telephone_number": "407-920-3321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 EXECUTIVE CENTER DR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328033529",
"telephone_number": "407-920-3321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUDGE",
"first_name": "LATRESSA",
"middle_name": "J",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-31",
"last_updated": "2012-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.