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General NPI Number Information
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NPI Number | 1104606979
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Entity Type | Individual
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Provider Name | JELENA DRAGOLJEVIC PA
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Gender | Female
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 315 N LAKEMONT AVE
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City | WINTER PARK
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State | FL
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Zip | 32792-3205
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Country | US
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Telephone | 407-622-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 594 TRELAGO WAY APT 307
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City | MAITLAND
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State | FL
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Zip | 32751-4349
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Country | US
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Telephone | 407-435-5067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | FL
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