Provider Demographics
NPI:1215214176
Name:INGRAHAM, GAYLE (MEDIT)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:MEDIT
Other - Prefix:MS
Other - First Name:GAYLE
Other - Middle Name:
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDIT
Mailing Address - Street 1:5520 W IDLEWILD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-8015
Mailing Address - Country:US
Mailing Address - Phone:813-901-3440
Mailing Address - Fax:813-882-3689
Practice Address - Street 1:5520 W IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-8015
Practice Address - Country:US
Practice Address - Phone:813-901-3440
Practice Address - Fax:813-882-3689
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator