Provider Demographics
NPI:1952703183
Name:BOGLE, TAJANA
Entity Type:Individual
Prefix:
First Name:TAJANA
Middle Name:
Last Name:BOGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3118
Mailing Address - Country:US
Mailing Address - Phone:407-276-3685
Mailing Address - Fax:407-674-8992
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL STE 227
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3195
Practice Address - Country:US
Practice Address - Phone:407-276-3685
Practice Address - Fax:407-674-8992
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator