Provider Demographics
NPI:1720188055
Name:RISCILE, GISELE REGINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:GISELE
Middle Name:REGINA
Last Name:RISCILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S DALE MABRY HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7800
Mailing Address - Country:US
Mailing Address - Phone:813-831-6000
Mailing Address - Fax:813-831-6002
Practice Address - Street 1:3201 S DALE MABRY HWY STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7800
Practice Address - Country:US
Practice Address - Phone:813-831-6000
Practice Address - Fax:813-831-6002
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE70634Medicare UPIN