MEDICARE: ELIZABETH GNAGY

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
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	OS13100	FL
2	2084P0800X	Psychiatry Physician	OS13100	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1982075826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GNAGY

Provider Business Mailing Address
First Line	:	122 E MAIN ST # 131
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4655
Country	:	US
Telephone Number	:	863-225-7097
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 E MAIN ST # 131
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4655
Country	:	US
Telephone Number	:	863-225-7097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2015
Last Update Date	:	03/09/2022

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