Provider Demographics
NPI:1922687995
Name:PHILOGENE, RONALD D (APRN)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:D
Last Name:PHILOGENE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 OLD DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2493
Mailing Address - Country:US
Mailing Address - Phone:561-356-8856
Mailing Address - Fax:
Practice Address - Street 1:701 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33469-2493
Practice Address - Country:US
Practice Address - Phone:561-356-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012516363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11012516OtherFLORIDA STATE BOARD OF NURSING