Healthcare Provider Details

I. General information

NPI: 1336660299
Provider Name (Legal Business Name): KRISTINA DRAGOVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W COPELAND DR
ORLANDO FL
32806-2002
US

IV. Provider business mailing address

1401 LUCERNE TER FL 2
ORLANDO FL
32806-2001
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-5281
  • Fax:
Mailing address:
  • Phone: 407-841-5297
  • Fax: 407-481-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN25137
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: