Provider Demographics
NPI:1043895006
Name:DYGDON, JACEK
Entity Type:Individual
Prefix:
First Name:JACEK
Middle Name:
Last Name:DYGDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-3613
Mailing Address - Country:US
Mailing Address - Phone:321-696-9464
Mailing Address - Fax:
Practice Address - Street 1:149 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3613
Practice Address - Country:US
Practice Address - Phone:321-696-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness