Provider Demographics
NPI:1700474251
Name:LUGO, JUDITH AWILDA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:AWILDA
Last Name:LUGO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 YEATS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6402
Mailing Address - Country:US
Mailing Address - Phone:407-380-9872
Mailing Address - Fax:
Practice Address - Street 1:4060 YEATS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6402
Practice Address - Country:US
Practice Address - Phone:407-380-9872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9236322163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care