Healthcare Provider Details

I. General information

NPI: 1861907313
Provider Name (Legal Business Name): DENISE DIGREGORIO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE RUSSO

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 LAKEWOOD RANCH BLVD SUITE 210
BRADENTON FL
34202-5185
US

IV. Provider business mailing address

367 S. GULPH RD ATTN: IPM CREDENTIALING
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-2800
  • Fax: 941-782-2513
Mailing address:
  • Phone: 941-782-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9395060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: