Provider Demographics
NPI:1164971586
Name:MAGNON, JUDITH (PSYCHIATRIC RN, CAC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MAGNON
Suffix:
Gender:F
Credentials:PSYCHIATRIC RN, CAC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:WING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYCHIATRIC RN, CAC
Mailing Address - Street 1:7300 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6012
Mailing Address - Country:US
Mailing Address - Phone:352-678-5553
Mailing Address - Fax:352-544-8354
Practice Address - Street 1:7300 GROVE RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6012
Practice Address - Country:US
Practice Address - Phone:352-678-5553
Practice Address - Fax:352-544-8354
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9179350163WP0808X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)