Provider Demographics
NPI:1194513473
Name:PERGOLIZZI, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:PERGOLIZZI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 BRYAN DAIRY RD STE 305
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1360
Mailing Address - Country:US
Mailing Address - Phone:727-391-5008
Mailing Address - Fax:
Practice Address - Street 1:8250 BRYAN DAIRY RD STE 305
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-1360
Practice Address - Country:US
Practice Address - Phone:727-391-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily