Healthcare Provider Details

I. General information

NPI: 1306014337
Provider Name (Legal Business Name): JUDITH GRACE MCDERMOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

13219 NE 32ND TER
GAINESVILLE FL
32609-8858
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-6047
  • Fax:
Mailing address:
  • Phone: 352-485-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1471162
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number1471162
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1471162
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number1471162
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1471162
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number1471162
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number1471162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: