Provider Demographics
NPI:1477686384
Name:TREGILLUS, SHIRLEY J (LM)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:J
Last Name:TREGILLUS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 JONES LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1603
Mailing Address - Country:US
Mailing Address - Phone:727-796-7502
Mailing Address - Fax:727-796-7502
Practice Address - Street 1:3060 JONES LN
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1603
Practice Address - Country:US
Practice Address - Phone:727-796-7502
Practice Address - Fax:727-796-7502
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW35175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay