Provider Demographics
NPI:1467987461
Name:SIGUA, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SIGUA
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 1:2708 W SAINT ISABEL ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6320
Mailing Address - Country:US
Mailing Address - Phone:813-870-1014
Mailing Address - Fax:
Practice Address - Street 1:2708 W. ST. ISABEL ST.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6320
Practice Address - Country:US
Practice Address - Phone:813-870-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9110315363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant