Provider Demographics
NPI:1992838536
Name:SIEMIONKO, PATRICIA E GRESKO (ARNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E GRESKO
Last Name:SIEMIONKO
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 1:1605 THONOTOSASSA RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4251
Mailing Address - Country:US
Mailing Address - Phone:813-707-0200
Mailing Address - Fax:813-717-7701
Practice Address - Street 1:770 DR. MARTIN LUTHER KING BLVD. WEST
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584
Practice Address - Country:US
Practice Address - Phone:813-654-7005
Practice Address - Fax:813-654-1050
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1727952363LF0000X
FLARNP1727952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 1727952OtherNURSE PRACTITIONER
FL004691200Medicaid
FLARNP 1727952OtherNURSE PRACTITIONER