Healthcare Provider Details

I. General information

NPI: 1477686384
Provider Name (Legal Business Name): SHIRLEY J. TREGILLUS LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 JONES LN
CLEARWATER FL
33759-1603
US

IV. Provider business mailing address

3060 JONES LN
CLEARWATER FL
33759-1603
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-7502
  • Fax: 727-796-7502
Mailing address:
  • Phone: 727-796-7502
  • Fax: 727-796-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberMW35
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: