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General NPI Number Information
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NPI Number | 1194183780
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Entity Type | Organization
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Legal Business Name | IPATIA MAGNUS
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 13910 FIVAY RD SUITE 1
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City | HUDSON
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State | FL
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Zip | 34667-7154
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Country | US
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Telephone | 727-863-0063
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Fax | 727-862-7163
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Provider Business Mailing Address
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Address Line | 13910 FIVAY RD SUITE 1
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City | HUDSON
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State | FL
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Zip | 34667-7154
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Country | US
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Telephone | 727-863-0063
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Fax | 727-862-7163
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Authorized Official
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Title or Position | PHD, PMHNP-BC
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Name | DR. IPATIA MAGNUS
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Credential | PHD, DNP, FPMHNP-BC
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Telephone | 727-863-0063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1961592
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License Number State | FL
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