Provider Demographics
NPI:1962412262
Name:AGRAIT, GEORGIA WARREN (ARNP)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:WARREN
Last Name:AGRAIT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CENTURY
Mailing Address - State:FL
Mailing Address - Zip Code:32535-0399
Mailing Address - Country:US
Mailing Address - Phone:850-256-5314
Mailing Address - Fax:850-256-4433
Practice Address - Street 1:8401 N CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:CENTURY
Practice Address - State:FL
Practice Address - Zip Code:32535
Practice Address - Country:US
Practice Address - Phone:850-256-5314
Practice Address - Fax:850-256-4433
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1773502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307632600Medicaid