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NPI Code Detail

MEDICARE: ANTOINETTE FREGOSO APN

MEDICARE: ANTOINETTE FREGOSO APN
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
1163W00000XRegistered NurseRN72796NM
2363LF0000XFamily Nurse PractitionerAPRN11004349FL
3363LF0000XFamily Nurse Practitioner1100439FL
4363L00000XNurse PractitionerAPRN11004349FL

General Provider Information

NPI Number : 1891053831
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTOINETTE FREGOSO APN
Provider Business Mailing Address
First Line : 106 W WINDHORST RD
Second Line :
City : BRANDON
State : FL
Zip : 33510-2455
Country : US
Telephone Number : 813-373-9531
Fax Number :
Provider Business Practice Location Address
First Line : 3919 TAMPA RD
Second Line :
City : OLDSMAR
State : FL
Zip : 34677-3114
Country : US
Telephone Number : 727-733-6111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2012
Last Update Date : 10/31/2020

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