Provider Demographics
NPI:1750967956
Name:AGRESTI, LOUISA KATHRYN (PHMNP-BC)
Entity type:Individual
Prefix:
First Name:LOUISA
Middle Name:KATHRYN
Last Name:AGRESTI
Suffix:
Gender:F
Credentials:PHMNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 95TH ST
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2426
Mailing Address - Country:US
Mailing Address - Phone:305-407-6031
Mailing Address - Fax:
Practice Address - Street 1:625 95TH ST
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-2426
Practice Address - Country:US
Practice Address - Phone:305-407-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012132363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health