Provider Demographics
NPI:1457354375
Name:AGRESTA, GIA P (MD)
Entity Type:Individual
Prefix:
First Name:GIA
Middle Name:P
Last Name:AGRESTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GIA
Other - Middle Name:
Other - Last Name:PITISCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 861295
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-1295
Mailing Address - Country:US
Mailing Address - Phone:813-636-2040
Mailing Address - Fax:813-636-2020
Practice Address - Street 1:1202 S CHURCH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5036
Practice Address - Country:US
Practice Address - Phone:813-254-8055
Practice Address - Fax:813-254-7240
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH93809Medicare UPIN
FL79518ZMedicare ID - Type Unspecified