Healthcare Provider Details

I. General information

NPI: 1114138799
Provider Name (Legal Business Name): RITA MAXINE JUNGMAN R.N.,A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 8TH AVE
HAVANA FL
32333-1731
US

IV. Provider business mailing address

305 E 8TH AVE
HAVANA FL
32333-1731
US

V. Phone/Fax

Practice location:
  • Phone: 860-539-0195
  • Fax:
Mailing address:
  • Phone: 860-539-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1677242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: