Provider Demographics
NPI:1558706887
Name:PETRAKOS, GINA (DO)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:PETRAKOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8242 LEXINGTON VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8055
Mailing Address - Country:US
Mailing Address - Phone:407-443-3428
Mailing Address - Fax:
Practice Address - Street 1:8242 LEXINGTON VIEW LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8055
Practice Address - Country:US
Practice Address - Phone:407-443-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital