Healthcare Provider Details

I. General information

NPI: 1609976471
Provider Name (Legal Business Name): DENISE E AGATEP MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 N ORANGE BLOSSOM TRL
ORLANDO FL
32810-1601
US

IV. Provider business mailing address

4780 N ORANGE BLOSSOM TRL
ORLANDO FL
32810-1601
US

V. Phone/Fax

Practice location:
  • Phone: 407-206-3326
  • Fax: 407-206-3316
Mailing address:
  • Phone: 904-271-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberME 90631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: