Provider Demographics
NPI:1073984365
Name:GOGINENI, KARUNASREE (PA-C)
Entity Type:Individual
Prefix:
First Name:KARUNASREE
Middle Name:
Last Name:GOGINENI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8293 SILVER BIRCH WAY
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-3721
Mailing Address - Country:US
Mailing Address - Phone:239-938-4168
Mailing Address - Fax:
Practice Address - Street 1:14171 METROPOLIS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4335
Practice Address - Country:US
Practice Address - Phone:239-561-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant