Healthcare Provider Details

I. General information

NPI: 1124831110
Provider Name (Legal Business Name): TABITHA ARIEL DUDAK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3889 MILITARY TRL STE 103
JUPITER FL
33458-2923
US

IV. Provider business mailing address

2962 SW SUNSET TRACE CIR
PALM CITY FL
34990-2627
US

V. Phone/Fax

Practice location:
  • Phone: 561-468-2370
  • Fax: 561-566-1884
Mailing address:
  • Phone: 561-662-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9588323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: