Provider Demographics
NPI:1619989076
Name:MAGNUS, IPATIA D (PHD, DNP, FPMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:IPATIA
Middle Name:D
Last Name:MAGNUS
Suffix:
Gender:F
Credentials:PHD, DNP, FPMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13910 FIVAY RD STE 8
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7130
Mailing Address - Country:US
Mailing Address - Phone:727-858-2007
Mailing Address - Fax:727-053-1696
Practice Address - Street 1:13910 FIVAY RD STE 8
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-858-2007
Practice Address - Fax:727-862-7163
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1961592363LP0808X, 364SP0810X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family