Provider Demographics
NPI:1205038411
Name:HOPE, GINA DALE (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:DALE
Last Name:HOPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26827 FOGGY CREEK RD BLDG 6, STE 101A
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6768
Mailing Address - Country:US
Mailing Address - Phone:813-973-7774
Mailing Address - Fax:813-973-8882
Practice Address - Street 1:26827 FOGGY CREEK RD BLDG 6, STE 101A
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6768
Practice Address - Country:US
Practice Address - Phone:813-973-7774
Practice Address - Fax:813-973-8882
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100329207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ755YOtherMEDICARE INDIVIDUAL PTAN
FL281130800Medicaid
FL99388OtherMEDICARE PTAN GROUP ASSOCIATION
FLAJ755YOtherMEDICARE INDIVIDUAL PTAN