Provider Demographics
NPI:1386028371
Name:GRGURICH, AMANDA MAE (BS)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:MAE
Last Name:GRGURICH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E TWIGGS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4019
Mailing Address - Country:US
Mailing Address - Phone:813-989-6600
Mailing Address - Fax:
Practice Address - Street 1:700 E TWIGGS ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4019
Practice Address - Country:US
Practice Address - Phone:813-989-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker