Individual provider Active NPI

Stephanie Goins Dagen, CPNP

  • Pediatric Nurse Practitioner
  • Orlando, FL
National Provider Identifier
1669838371
Registry record updated Jan 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
APRN9494032 Issued in FL
Practice address
615 E Princeton St Ste 540
Orlando, FL 32803-1424
Phone
(407) 303-9980
Fax
(407) 303-9987
NPI assigned
Jan 11, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 5008290 NC
Pediatric Nurse Practitioner 363LP0200X APRN9494032 FL Primary

Addresses

Primary practice location

615 E Princeton St Ste 540
Orlando, FL 32803-1424

Mailing address

615 E Princeton St Ste 540
Orlando, FL 32803-1424
Phone (407) 303-9980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190117003149 FL Practitioner - Nurse Practitioner 3577809193 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN9494032FLMDPediatric Nurse Practitioner
5008290NCMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc CurrentSince Dec 3, 2018 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Dec 3, 2018 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

615 E Princeton St
Ste 540
Orlando, FL 32803
Phone (407) 303-8127

Interoperability endpoints

  • Direct secure messaging: sdagen73098@adventhealth.direct-ci.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546387200000",
    "number": "1669838371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 E PRINCETON ST STE 540",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031424",
            "telephone_number": "407-303-9980",
            "fax_number": "407-303-9987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 E PRINCETON ST STE 540",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328031424",
            "telephone_number": "407-303-9980",
            "fax_number": "407-303-9987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAGEN",
        "first_name": "STEPHANIE",
        "middle_name": "GOINS",
        "name_prefix": "Mrs.",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-11",
        "last_updated": "2019-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5008290",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "APRN9494032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.