Healthcare Provider Details

I. General information

NPI: 1609514132
Provider Name (Legal Business Name): INGRID DRAUTZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 SW 12TH AVE STE 102
POMPANO BEACH FL
33069-3593
US

IV. Provider business mailing address

555 SW 12TH AVE STE 102
POMPANO BEACH FL
33069-3593
US

V. Phone/Fax

Practice location:
  • Phone: 954-339-6863
  • Fax:
Mailing address:
  • Phone: 954-339-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN9190054
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11020201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: