Provider Demographics
NPI:1386172906
Name:TUGGERSON, DERRICK WAYNE JR (CNA)
Entity type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:WAYNE
Last Name:TUGGERSON
Suffix:JR
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3344 SW 51ST TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-9484
Mailing Address - Country:US
Mailing Address - Phone:352-299-1961
Mailing Address - Fax:352-575-1080
Practice Address - Street 1:3344 SW 51ST TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-9484
Practice Address - Country:US
Practice Address - Phone:352-299-1961
Practice Address - Fax:352-575-1080
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372500000X, 373H00000X, 3747A0650X, 3747P1801X, 376J00000X, 390200000X, 374U00000X
FLAHCHA372500000X
FLFL19650372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program