Provider Demographics
NPI:1255584173
Name:RAGAN, RITA TESTA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:TESTA
Last Name:RAGAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SOUTHPARK BLVD C300
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4162
Mailing Address - Country:US
Mailing Address - Phone:904-808-7246
Mailing Address - Fax:904-808-7090
Practice Address - Street 1:2089 SOUTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6478
Practice Address - Country:US
Practice Address - Phone:662-407-0801
Practice Address - Fax:662-821-0422
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9405872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily