Provider Demographics
NPI:1679026017
Name:KLUG, RONALD GARY (DNP-AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:GARY
Last Name:KLUG
Suffix:
Gender:M
Credentials:DNP-AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N MILLS AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1460
Mailing Address - Country:US
Mailing Address - Phone:407-894-4880
Mailing Address - Fax:407-894-2364
Practice Address - Street 1:1900 N MILLS AVE STE 107
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1460
Practice Address - Country:US
Practice Address - Phone:407-894-4880
Practice Address - Fax:407-894-2364
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8652363LA2100X
FL11018286363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care