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NPI Code Detail

MEDICARE: DR. NICHOLAS J. AGRESTI MD

MEDICARE: DR. NICHOLAS J. AGRESTI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology PhysicianME115292FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669634010
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICHOLAS J. AGRESTI MD
Provider Business Mailing Address
First Line : 4800 BELFORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-6004
Country : US
Telephone Number : 904-398-7205
Fax Number :
Provider Business Practice Location Address
First Line : 1824 KING ST STE 300
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4736
Country : US
Telephone Number : 904-381-9393
Fax Number : 904-381-9314
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2008
Last Update Date : 02/26/2026

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