Provider Demographics
NPI:1679289359
Name:AGUILA, GREGORY MIGUEL
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MIGUEL
Last Name:AGUILA
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 1:10762 SE US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3805
Mailing Address - Country:US
Mailing Address - Phone:352-347-5225
Mailing Address - Fax:
Practice Address - Street 1:10762 SE US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3805
Practice Address - Country:US
Practice Address - Phone:352-347-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11023116OtherAPRN LICENSE