Provider Demographics
NPI:1467592980
Name:AGAZZI, HEATHER LEANNE CURTISS (PHD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEANNE CURTISS
Last Name:AGAZZI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEANNE
Other - Last Name:CURTISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13101 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3803
Practice Address - Country:US
Practice Address - Phone:813-396-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7817103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75614OtherBLUE CROSS BLUE SHIELD
BN229YMedicare PIN