Provider Demographics
NPI:1588695332
Name:CLEMONS RUGULO, ANDREA (ARNP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:CLEMONS RUGULO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:J CLEMONS
Other - Last Name:RUGULO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-392-4195
Mailing Address - Fax:352-392-9802
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:BOX 100371
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-4195
Practice Address - Fax:352-392-9802
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2631822363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305806900Medicaid
FL305806900Medicaid