Provider Demographics
NPI:1043694789
Name:DOUGHERTY, AMORCITA MADRIDONDO (AR)
Entity type:Individual
Prefix:
First Name:AMORCITA
Middle Name:MADRIDONDO
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:AR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-5220
Mailing Address - Country:US
Mailing Address - Phone:813-331-3940
Mailing Address - Fax:813-331-3941
Practice Address - Street 1:3040 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5220
Practice Address - Country:US
Practice Address - Phone:813-331-3940
Practice Address - Fax:813-331-3941
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9367297363LA2200X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology