1992838536 NPI number — PATRICIA E GRESKO SIEMIONKO ARNP

Table of content: PATRICIA E GRESKO SIEMIONKO ARNP (NPI 1992838536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992838536 NPI number — PATRICIA E GRESKO SIEMIONKO ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEMIONKO
Provider First Name:
PATRICIA
Provider Middle Name:
E GRESKO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992838536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 THONOTOSASSA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANT CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33563-4251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-707-0200
Provider Business Mailing Address Fax Number:
813-717-7701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 DR. MARTIN LUTHER KING BLVD. WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEFFNER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-654-7005
Provider Business Practice Location Address Fax Number:
813-654-1050
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP 1727952 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: ARNP1727952 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ARNP 1727952 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 004691200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".