Provider Demographics
NPI:1114435278
Name:BUGAYONG, KATHLEEN N (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:N
Last Name:BUGAYONG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:N
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1322 SHADEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-2593
Mailing Address - Country:US
Mailing Address - Phone:352-212-2650
Mailing Address - Fax:
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9350358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily