Provider Demographics
NPI:1255205290
Name:ENCARNACION, URDIF T
Entity type:Individual
Prefix:
First Name:URDIF
Middle Name:T
Last Name:ENCARNACION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 CHANDLER DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-9327
Mailing Address - Country:US
Mailing Address - Phone:786-612-1213
Mailing Address - Fax:786-612-1213
Practice Address - Street 1:432 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-9327
Practice Address - Country:US
Practice Address - Phone:786-612-1213
Practice Address - Fax:786-612-1213
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11042509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily