Provider Demographics
NPI:1366092553
Name:HARGRETT, GREG II
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:HARGRETT
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 E STATE ROAD 60
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33567-3827
Mailing Address - Country:US
Mailing Address - Phone:813-379-1634
Mailing Address - Fax:
Practice Address - Street 1:2419 E STATE ROAD 60
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33567-3827
Practice Address - Country:US
Practice Address - Phone:813-379-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider