Provider Demographics
NPI:1174535595
Name:DRAGON, JUDITH (ARNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:DRAGON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 E MARION AVE
Mailing Address - Street 2:STE 141
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3872
Mailing Address - Country:US
Mailing Address - Phone:941-205-3200
Mailing Address - Fax:941-639-7576
Practice Address - Street 1:713 E MARION AVE
Practice Address - Street 2:STE 141
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3872
Practice Address - Country:US
Practice Address - Phone:941-205-3200
Practice Address - Fax:941-639-7576
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1611472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S54623Medicare UPIN
FLE0656ZMedicare PIN