Provider Demographics
NPI:1073506267
Name:VARGAS, GISELA (MD)
Entity Type:Individual
Prefix:MS
First Name:GISELA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E 1ST ST
Mailing Address - Street 2:P.O. BOX 91988
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4609
Mailing Address - Country:US
Mailing Address - Phone:863-682-0843
Mailing Address - Fax:863-687-3971
Practice Address - Street 1:5015 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5303
Practice Address - Country:US
Practice Address - Phone:813-988-4400
Practice Address - Fax:813-988-4401
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8003WMedicare PIN
FL265102500Medicaid
FLP00287417Medicare PIN
G08839Medicare UPIN
FL49070OtherBLUE CROSS BLUE SHIELD