Provider Demographics
NPI:1568405579
Name:DASILVA, JUDY R (DNP, MSN, ARNP, FNP)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:R
Last Name:DASILVA
Suffix:
Gender:F
Credentials:DNP, MSN, ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-2832
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:1095 NW ST LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7564
Practice Address - Country:US
Practice Address - Phone:772-785-5570
Practice Address - Fax:772-785-5553
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2136652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306082900Medicaid
FLQ13082Medicare UPIN
FL306082900Medicaid