Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN9449253 | FL |
NPI | 1003332685 |
---|---|
Provider Name | Asti Elizabeth Rego |
First Address | Tampa, FL 33611-2858 |
Second Address | Clearwater, FL 33765-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 16/08/2017 |