Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | ME118987 | FL |
Y | 207RN0300X | Nephrologist | ME118987 | FL |
NPI | 1013160043 |
---|---|
Provider Name | Dr. Gina Marie Iacovella |
First Address | Tempe, AZ 85284-3495 |
Second Address | Riverview, FL 33578-2594 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 27/01/2022 |