Provider Demographics
NPI:1669589891
Name:TOLENTINO, AGNES T (MD)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:T
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 HOLLINGSWORTH OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2355
Mailing Address - Country:US
Mailing Address - Phone:863-682-3898
Mailing Address - Fax:863-682-3898
Practice Address - Street 1:1450 HOLLINGSWORTH OAKS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2355
Practice Address - Country:US
Practice Address - Phone:863-682-3898
Practice Address - Fax:863-682-3898
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME918112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry