Provider Demographics
NPI:1801085519
Name:BRUGGEMANN, JANET TRACY (MA)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:TRACY
Last Name:BRUGGEMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 WOOD ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7903
Mailing Address - Country:US
Mailing Address - Phone:941-955-2593
Mailing Address - Fax:941-955-2684
Practice Address - Street 1:2055 WOOD ST
Practice Address - Street 2:SUITE 118
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7903
Practice Address - Country:US
Practice Address - Phone:941-955-2593
Practice Address - Fax:941-955-2684
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH # 5140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768360000Medicaid