Individual provider Active NPI

Judith A Flanagan, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Maitland, FL
National Provider Identifier
1710058060
Registry record updated Aug 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
ARNP436302 Issued in FL
Practice address
2700 Westhall LN Ste 207
Maitland, FL 32751-7478
Phone
(800) 840-2528
NPI assigned
Nov 10, 2006
Last updated
Aug 15, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X ARNP436302 FL Primary

Addresses

Primary practice location

2700 Westhall LN Ste 207
Maitland, FL 32751-7478

Mailing address

355 Pawnee TRL
Winter Springs, FL 32708-5159
Phone (407) 415-2170

Other identifiers 1

IdentifierTypeStateIssuer
007194800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ARNP436302FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Psychamerica Behavioral Services LLC CurrentSince Aug 18, 2019 Accepting new patients
Adly Thebaud,MD,PA Psychiatric/Mental Health PastSince Mar 10, 1998 Accepting new patients

Locations

2700 Westhall Ln
Ste 207
Maitland, FL 32751
Phone (407) 636-3532

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1710058060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 PAWNEE TRL",
            "city": "WINTER SPRINGS",
            "state": "FL",
            "postal_code": "327085159",
            "telephone_number": "407-415-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 WESTHALL LN STE 207",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517478",
            "telephone_number": "800-840-2528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLANAGAN",
        "first_name": "JUDITH",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-10",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP436302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007194800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.