Provider Demographics
NPI:1306014337
Name:MCDERMOTT, JUDITH GRACE (RN)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:GRACE
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13219 NE 32ND TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8858
Mailing Address - Country:US
Mailing Address - Phone:352-485-2396
Mailing Address - Fax:
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-374-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1471162163WC0200X, 163WC1500X, 163WE0003X, 163WM0102X, 163WN0002X, 163WN0003X, 163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient