Provider Demographics
NPI:1871131839
Name:OREJUDOS, MYLA ESPANOL (APRN)
Entity type:Individual
Prefix:
First Name:MYLA
Middle Name:ESPANOL
Last Name:OREJUDOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4369
Mailing Address - Country:US
Mailing Address - Phone:904-239-1459
Mailing Address - Fax:
Practice Address - Street 1:165 WELLS RD STE 404
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-3037
Practice Address - Country:US
Practice Address - Phone:904-264-3111
Practice Address - Fax:904-264-3213
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003773363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty