Provider Demographics
NPI:1194183780
Name:IPATIA MAGNUS
Entity Type:Organization
Organization Name:IPATIA MAGNUS
Other - Org Name:BAY AREA COUNSELING & PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHD, PMHNP-BC
Authorized Official - Prefix:DR
Authorized Official - First Name:IPATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DNP, FPMHNP-BC
Authorized Official - Phone:727-863-0063
Mailing Address - Street 1:13910 FIVAY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7154
Mailing Address - Country:US
Mailing Address - Phone:727-863-0063
Mailing Address - Fax:727-862-7163
Practice Address - Street 1:13910 FIVAY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7154
Practice Address - Country:US
Practice Address - Phone:727-863-0063
Practice Address - Fax:727-862-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1961592363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty