Provider Demographics
NPI:1366178543
Name:FLORIAL, AGNOLITE
Entity type:Individual
Prefix:
First Name:AGNOLITE
Middle Name:
Last Name:FLORIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 BULRUSH CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3487
Mailing Address - Country:US
Mailing Address - Phone:561-577-8182
Mailing Address - Fax:
Practice Address - Street 1:6727 BULRUSH CT
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3487
Practice Address - Country:US
Practice Address - Phone:561-577-8182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily