Provider Demographics
NPI:1447621420
Name:HEPBURN, JUDITH (ARNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:HEPBURN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:PRATER-HEPBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:430 COLLEGE DR
Mailing Address - Street 2:SUITE 100-102
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8530
Mailing Address - Country:US
Mailing Address - Phone:904-644-8669
Mailing Address - Fax:904-298-1973
Practice Address - Street 1:120 KING ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-2410
Practice Address - Country:US
Practice Address - Phone:904-760-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP659092363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics