Healthcare Provider Details

I. General information

NPI: 1619989076
Provider Name (Legal Business Name): IPATIA D MAGNUS PHD, DNP, FPMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13910 FIVAY RD STE 8
HUDSON FL
34667
US

IV. Provider business mailing address

13910 FIVAY RD STE 8
HUDSON FL
34667-7130
US

V. Phone/Fax

Practice location:
  • Phone: 727-858-2007
  • Fax: 727-862-7163
Mailing address:
  • Phone: 727-858-2007
  • Fax: 727-053-1696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1961592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: