Provider Demographics
NPI:1114138799
Name:JUNGMAN, RITA MAXINE (RN,ARNP)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:MAXINE
Last Name:JUNGMAN
Suffix:
Gender:F
Credentials:RN,ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-1731
Mailing Address - Country:US
Mailing Address - Phone:860-539-0195
Mailing Address - Fax:
Practice Address - Street 1:305 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-1731
Practice Address - Country:US
Practice Address - Phone:860-539-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1677242363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ61006Medicare UPIN
FLY085WMedicare ID - Type Unspecified