Provider Demographics
NPI:1639373962
Name:PRISKA, RUDINA X (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDINA
Middle Name:X
Last Name:PRISKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:2304 ALOMA AVE STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3330
Practice Address - Country:US
Practice Address - Phone:407-679-9222
Practice Address - Fax:407-679-9061
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 116286OtherMEDICAL LICENSE
FLME 116286OtherMEDICAL LICENSE
FLME 116286OtherMEDICAL LICENSE
FLFP0315285OtherDEA LICENSE
MIFP0315285OtherDEA
MIN25400006Medicare PIN
FLFP0315285OtherDEA LICENSE