Provider Demographics
NPI:1548074511
Name:DORGILUS, JEFTERSON (DNP)
Entity type:Individual
Prefix:DR
First Name:JEFTERSON
Middle Name:
Last Name:DORGILUS
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-2715
Mailing Address - Country:US
Mailing Address - Phone:561-768-1842
Mailing Address - Fax:
Practice Address - Street 1:241 NW 4TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-2715
Practice Address - Country:US
Practice Address - Phone:561-768-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-01
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152459367500000X
TX1191819367500000X
AZ152459367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered