Healthcare Provider Details

I. General information

NPI: 1912500406
Provider Name (Legal Business Name): TONYA LYNN DAGDA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 01/01/2021
Certification Date: 01/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 SEBRING SQ
SEBRING FL
33870-1602
US

IV. Provider business mailing address

410 SEBRING SQ
SEBRING FL
33870-1602
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-2229
  • Fax: 863-385-2229
Mailing address:
  • Phone: 863-382-2229
  • Fax: 863-385-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11000945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: