Provider Demographics
NPI:1194388967
Name:GRAY, SHAMEEKA R (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHAMEEKA
Middle Name:R
Last Name:GRAY
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 E LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-8272
Mailing Address - Country:US
Mailing Address - Phone:229-462-6929
Mailing Address - Fax:
Practice Address - Street 1:10013 WATER WORKS LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5304
Practice Address - Country:US
Practice Address - Phone:813-252-0171
Practice Address - Fax:883-941-2369
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017747363LF0000X, 363LP0808X
VA0024186297363LF0000X, 363LP0808X
GARN227455363LF0000X, 363LP0808X
TN30130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily