Healthcare Provider Details

I. General information

NPI: 1013871003
Provider Name (Legal Business Name): JAMAICA MIA DAGDAGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N ORANGE BLOSSOM TRL STE 302
KISSIMMEE FL
34744-2308
US

IV. Provider business mailing address

2400 N ORANGE BLOSSOM TRL STE 302
KISSIMMEE FL
34744-2308
US

V. Phone/Fax

Practice location:
  • Phone: 407-932-6193
  • Fax: 407-932-6194
Mailing address:
  • Phone: 407-932-6193
  • Fax: 407-932-6194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11044148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: