Healthcare Provider Details

I. General information

NPI: 1164459103
Provider Name (Legal Business Name): JUDY A OGNIBENE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDY FRIEDLI

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2634 CAPITAL CIR NE BLDG C
TALLAHASSEE FL
32308-4106
US

IV. Provider business mailing address

2634 CAPITAL CIR NE BLDG C
TALLAHASSEE FL
32308-4106
US

V. Phone/Fax

Practice location:
  • Phone: 850-523-3289
  • Fax: 850-523-3334
Mailing address:
  • Phone: 850-523-3333
  • Fax: 850-523-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26674
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: