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General NPI Number Information
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NPI Number | 1316779721
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Entity Type | Individual
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Provider Name | JUDY WANJIRU NGANGA NP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2024
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 200 PARK PLACE BLVD
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City | KISSIMMEE
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State | FL
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Zip | 34741-2344
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Country | US
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Telephone | 407-846-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 2819 MONTICELLO WAY
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City | KISSIMMEE
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State | FL
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Zip | 34741-7028
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Country | US
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Telephone | 407-973-4327
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 11031900
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License Number State | FL
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