Basic Information
| Provider Information | |||||||||
| NPI: | 1174535595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRAGON | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | |||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 713 E MARION AVE | ||||||||
| Address2: | STE 141 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412053200 | ||||||||
| FaxNumber: | 9416397576 | ||||||||
| Practice Location | |||||||||
| Address1: | 713 E MARION AVE | ||||||||
| Address2: | STE 141 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412053200 | ||||||||
| FaxNumber: | 9416397576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 05/26/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN1611472 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.