Provider Demographics
NPI:1255022240
Name:REDMOND-DAVILA, LOGAN (APRN)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:REDMOND-DAVILA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23343 NW COUNTY ROAD 236
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-9669
Mailing Address - Country:US
Mailing Address - Phone:386-454-0698
Mailing Address - Fax:
Practice Address - Street 1:1830 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:FL
Practice Address - Zip Code:32619-4713
Practice Address - Country:US
Practice Address - Phone:352-463-1100
Practice Address - Fax:352-463-3924
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9461247163W00000X
FLAPRN11026529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse