Provider Demographics
NPI:1144763954
Name:AGRUSTI, THOMAS
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:AGRUSTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7122 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-8730
Mailing Address - Country:US
Mailing Address - Phone:973-609-3691
Mailing Address - Fax:
Practice Address - Street 1:7122 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-8730
Practice Address - Country:US
Practice Address - Phone:973-609-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker