MR. JUDSON FANN (NPI# 1982806519) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982806519 |
| Entity Type | Individual |
| Full Name | MR. JUDSON FANN |
| Credential | MS, ATC, LAT, CSCS |
| Practice Address |
421 N Woodland Blvd Unit 8317 Deland FL 32723-0001 |
| Mailing Address |
118 E Villa Capri Cir Apt. A Deland FL 32724-7866 |
| Practice Telephone | 3868227166 |
| Mailing Telephone | 3868486715 |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
AL1982 | FL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
421 N WOODLAND BLVD UNIT 8317 |
| City | DELAND |
| State | FL |
| Zip Code | 32723-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407984198 | David Schenck Rauschenberger | Family Medicine | 421 N Woodland Blvd, Unit 8415, Deland, FL 32723-0001 | 2007-03-02 |
| 1417401191 | John Travnick | Specialist/Technologist | 421 N Woodland Blvd, Deland, FL 32723-8300 | 2016-08-10 |
| 1386005650 | Seth Tisdale | Specialist/Technologist | 421 N Woodland Blvd, Unit 8284, Deland, FL 32723-8300 | 2016-03-15 |
| 1912368192 | Taylor Anne Sullivan | Specialist/Technologist | 421 N Woodland Blvd, Unit 8284, Deland, FL 32723-8300 | 2016-03-15 |
| 1821459009 | Kristen Mcternan | Specialist/Technologist | 421 N Woodland Blvd, 8317, Deland, FL 32723-8300 | 2016-03-15 |
| 1952745887 | David Allen Krazeise | Specialist/Technologist | 421 N Woodland Blvd, Unit 8284, Deland, FL 32723-8300 | 2013-04-22 |
| 1659714061 | Rachel Anne Craddock | Specialist/Technologist | 421 N Woodland Blvd, Unit 8317, Deland, FL 32723-8300 | 2013-04-16 |
| 1952647372 | Carrie Rahn | Specialist/Technologist | 421 N Woodland Blvd, Deland, FL 32723-8300 | 2012-12-13 |
| 1396010328 | Daniel L. Riegle | Specialist/Technologist | 421 N Woodland Blvd, Unit 8317, Deland, FL 32723-0001 | 2012-03-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720255847 | Edrian J Hairston | Specialist/Technologist | Stetson University 421 N Woodland Blvd, Unit 8317, Deland, FL 32723-0001 | 2008-05-08 |
| 1255534210 | Stephanie Marie Pruitt | Specialist/Technologist | 421 Woodland Blvd, Unit 8317, Deland, FL 32723-0001 | 2007-06-07 |
| 1518176262 | Jamie M Mcclure | Specialist/Technologist | 421 N Woodland Blvd Unit 8317, Deland, FL 32723-0001 | 2007-05-21 |
| 1982812590 | Glenn R. Brickey | Specialist/Technologist | Stetson University, 421 N. Woodland Blvd., Unit 8317, Deland, FL 32723-0001 | 2007-05-18 |
| 1689018590 | Andrew J Kovachy | Specialist/Technologist | 421 N Woodland Blvd Unit 8284, Deland, FL 32723-8417 | 2013-04-22 |
| 1780036301 | Miriam Hosmon | Specialist/Technologist | 421 N Woodland Blvd Unit 8317, Deland, FL 32723-8417 | 2016-07-07 |
| 1942650957 | Logan Speicher | Specialist/Technologist | 421 N Woodland Blvd Unit 8317, Deland, FL 32723-8418 | 2016-06-21 |
| 1033569652 | Barbara Lawrence | Specialist/Technologist | 421 N Woodland Blvd Unit 8317, Deland, FL 32723-8418 | 2016-06-14 |
| 1962670307 | Timothy D Miesmer | Specialist | 421 N Woodland Blvd Unit 8317, Deland, FL 32723-8418 | 2008-02-20 |
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093288136 | Lisa G Rozental | Specialist/Technologist | 120 Los Arbor Dr, Deland, FL 32724-1263 | 2019-01-10 |
| 1255877221 | Emily Eunice | Specialist/Technologist | 2589 W Lake Dr., Deland, FL 32724 | 2017-01-13 |
| 1689018590 | Andrew J Kovachy | Specialist/Technologist | 421 N Woodland Blvd Unit 8284, Deland, FL 32723-8417 | 2013-04-22 |
| 1720255847 | Edrian J Hairston | Specialist/Technologist | Stetson University 421 N Woodland Blvd, Unit 8317, Deland, FL 32723-0001 | 2008-05-08 |
| 1255534210 | Stephanie Marie Pruitt | Specialist/Technologist | 421 Woodland Blvd, Unit 8317, Deland, FL 32723-0001 | 2007-06-07 |
| 1518176262 | Jamie M Mcclure | Specialist/Technologist | 421 N Woodland Blvd Unit 8317, Deland, FL 32723-0001 | 2007-05-21 |
| 1982812590 | Glenn R. Brickey | Specialist/Technologist | Stetson University, 421 N. Woodland Blvd., Unit 8317, Deland, FL 32723-0001 | 2007-05-18 |
| 1568429017 | Jeffrey William Bishop | Specialist/Technologist | Deland High School, 800 N. Hill Ave, Deland, FL 32724 | 2006-04-27 |
| 1144283326 | John Earl Mcfarland | Specialist/Technologist | 1764 S Woodland Blvd, Deland, FL 32720-7915 | 2006-04-10 |
| 1417401191 | John Travnick | Specialist/Technologist | 421 N Woodland Blvd, Deland, FL 32723-8300 | 2016-08-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.