Provider Demographics
NPI:1023113537
Name:JUSTIS, GINA BRIGITTE (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:BRIGITTE
Last Name:JUSTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1785 SABOFF WAY
Mailing Address - Street 2:
Mailing Address - City:CHULUOTA
Mailing Address - State:FL
Mailing Address - Zip Code:32766-8811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5425 S SEMORAN BLVD STE 11
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1777
Practice Address - Country:US
Practice Address - Phone:407-658-4616
Practice Address - Fax:407-658-4617
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045542207L00000X
FLME130757207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology