Provider Demographics
NPI:1629035993
Name:DUDLEY, JANELLE V (PA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:V
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:L
Other - Last Name:VARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:12416 66TH ST N
Mailing Address - Street 2:STE A
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3437
Mailing Address - Country:US
Mailing Address - Phone:727-547-4700
Mailing Address - Fax:727-394-8661
Practice Address - Street 1:12416 66TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3437
Practice Address - Country:US
Practice Address - Phone:727-547-4700
Practice Address - Fax:727-394-8661
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103041363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical