Provider Demographics
NPI:1215764261
Name:SCOGGINS, CONSUELO ALEXANDRA (AGNP-C)
Entity type:Individual
Prefix:MS
First Name:CONSUELO
Middle Name:ALEXANDRA
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 WELLINGBOROUGH CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-0023
Mailing Address - Country:US
Mailing Address - Phone:813-992-1851
Mailing Address - Fax:
Practice Address - Street 1:3814 WELLINGBOROUGH CT
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-0023
Practice Address - Country:US
Practice Address - Phone:813-992-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031857363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care