Healthcare Provider Details

I. General information

NPI: 1154300895
Provider Name (Legal Business Name): JERRY RAGNAUTH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 CITRUS MEDICAL CT STE 101
OCOEE FL
34761-4548
US

IV. Provider business mailing address

5365 W ATLANTIC AVE STE 504
DELRAY BEACH FL
33484-8194
US

V. Phone/Fax

Practice location:
  • Phone: 407-622-7246
  • Fax: 407-599-7246
Mailing address:
  • Phone: 561-241-9300
  • Fax: 561-241-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3325482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: