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General NPI Number Information
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NPI Number | 1700392727
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Entity Type | Individual
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Provider Name | RONA TAGALOG ARNP
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Gender | Female
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1707 MAYO DR
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City | TAVARES
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State | FL
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Zip | 32778-4307
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Country | US
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Telephone | 352-253-2511
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Fax |
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Provider Business Mailing Address
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Address Line | 934 VALLEYWAY DR
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City | APOPKA
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State | FL
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Zip | 32712-5491
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Country | US
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Telephone | 407-782-4298
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9251396
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License Number State | FL
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