Healthcare Provider Details

I. General information

NPI: 1275453169
Provider Name (Legal Business Name): ANASTASIA KARGAKOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 USF HEALTH DR.
TAMPA FL
33612
US

IV. Provider business mailing address

4615 MANDOLIN LOOP
WINTER HAVEN FL
33884-3599
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-2191
  • Fax:
Mailing address:
  • Phone: 863-307-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9569954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: