Healthcare Provider Details

I. General information

NPI: 1992588602
Provider Name (Legal Business Name): GINA PITOCCHELLI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 NE 155TH CT
WILLISTON FL
32696-9054
US

IV. Provider business mailing address

816 NE 155TH CT
WILLISTON FL
32696-9054
US

V. Phone/Fax

Practice location:
  • Phone: 352-672-7791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GINA PITOCCHELLI
Title or Position: OWNER
Credential:
Phone: 352-672-7791