Provider Demographics
NPI:1992413215
Name:AGOLLI, EZELA (DNP, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:EZELA
Middle Name:
Last Name:AGOLLI
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 HAMLIN BLVD APT 804
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-1022
Mailing Address - Country:US
Mailing Address - Phone:727-455-4421
Mailing Address - Fax:
Practice Address - Street 1:4156 WOODLANDS PKWY STE B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3478
Practice Address - Country:US
Practice Address - Phone:727-372-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021295363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics