Provider Demographics
NPI:1043785041
Name:UKAGA, ANTHONIA C
Entity Type:Individual
Prefix:
First Name:ANTHONIA
Middle Name:C
Last Name:UKAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 EAGLE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1206
Mailing Address - Country:US
Mailing Address - Phone:850-570-7078
Mailing Address - Fax:
Practice Address - Street 1:35 APALACHEE DR
Practice Address - Street 2:
Practice Address - City:SNEADS
Practice Address - State:FL
Practice Address - Zip Code:32460-4166
Practice Address - Country:US
Practice Address - Phone:850-593-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9213855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily