Provider Demographics
NPI:1154300895
Name:RAGNAUTH, JERRY (ARNP)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:RAGNAUTH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5365 W ATLANTIC AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8194
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-241-9339
Practice Address - Street 1:1530 CITRUS MEDICAL CT STE 101
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4548
Practice Address - Country:US
Practice Address - Phone:407-622-7246
Practice Address - Fax:407-599-7246
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3325482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3241VOtherMEDICARE PTAN
FLU3241UOtherMEDICARE PTAN
FLU3241TOtherMEDICARE PTAN