Provider Demographics
NPI:1518654847
Name:RAZGAUSKAYTE, ILONA VLADOVNA (APRN)
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:VLADOVNA
Last Name:RAZGAUSKAYTE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-2813
Mailing Address - Country:US
Mailing Address - Phone:763-614-7389
Mailing Address - Fax:
Practice Address - Street 1:JOHN E. GOODE PRE-TRIAL DETENTION FACILITY
Practice Address - Street 2:500 E ADAMS ST
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202
Practice Address - Country:US
Practice Address - Phone:904-630-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily