Healthcare Provider Details

I. General information

NPI: 1992838536
Provider Name (Legal Business Name): PATRICIA E GRESKO SIEMIONKO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 DR. MARTIN LUTHER KING BLVD. WEST
SEFFNER FL
33584
US

IV. Provider business mailing address

1605 THONOTOSASSA RD
PLANT CITY FL
33563-4251
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-7005
  • Fax: 813-654-1050
Mailing address:
  • Phone: 813-707-0200
  • Fax: 813-717-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 1727952
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1727952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: