MEDICARE: WILLIAM LAGROSA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	88144	NE
2	246ZC0007X	Surgical Assistant	4555	MN
3	363L00000X	Nurse Practitioner	11020638	FL

General Provider Information

NPI Number	:	1518599935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM LAGROSA APRN

Provider Business Mailing Address
First Line	:	1690 HUBBELL RD
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-7239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10740 PALM RIVER RD STE 300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-4577
Country	:	US
Telephone Number	:	813-651-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	07/27/2022

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Directions to “ WILLIAM LAGROSA APRN” Practice Location

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