Provider Demographics
NPI:1003332313
Name:ROTH, GAIL DEANNE (ARNP-C)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:DEANNE
Last Name:ROTH
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 BROWNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1118
Mailing Address - Country:US
Mailing Address - Phone:813-679-4101
Mailing Address - Fax:
Practice Address - Street 1:4604 BROWNWOOD CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1118
Practice Address - Country:US
Practice Address - Phone:813-679-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9233626363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology