Healthcare Provider Details

I. General information

NPI: 1023113537
Provider Name (Legal Business Name): GINA BRIGITTE JUSTIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 S SEMORAN BLVD STE 11
ORLANDO FL
32822-1777
US

IV. Provider business mailing address

1785 SABOFF WAY
CHULUOTA FL
32766-8811
US

V. Phone/Fax

Practice location:
  • Phone: 407-658-4616
  • Fax: 407-658-4617
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101045542
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME130757
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: