Provider Demographics
NPI:1821645565
Name:URGO, NINA LEE
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:LEE
Last Name:URGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 16TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4514
Mailing Address - Country:US
Mailing Address - Phone:727-823-9058
Mailing Address - Fax:
Practice Address - Street 1:115 16TH AVE NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4514
Practice Address - Country:US
Practice Address - Phone:727-823-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider