MEDICARE: UGONNA DURU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11007975	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP95021659	CA
3	163W00000X	Registered Nurse	11007975	FL
4	363LF0000X	Family Nurse Practitioner	11007975	FL

General Provider Information

NPI Number	:	1205425386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UGONNA DURU

Provider Business Mailing Address
First Line	:	12610 HENDERSON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-6548
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12610 HENDERSON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-6548
Country	:	US
Telephone Number	:	813-592-8958
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	12/05/2025

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Directions to “ UGONNA DURU ” Practice Location

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