Provider Demographics
NPI:1235463266
Name:GASKIN, TINA GAIL (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:GAIL
Last Name:GASKIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 LPGA BLVD
Mailing Address - Street 2:STE. 136
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5115
Mailing Address - Country:US
Mailing Address - Phone:386-274-4750
Mailing Address - Fax:386-274-2499
Practice Address - Street 1:1410 LPGA BLVD
Practice Address - Street 2:STE. 136
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5115
Practice Address - Country:US
Practice Address - Phone:386-274-4750
Practice Address - Fax:386-274-2499
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9211084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0015594400Medicaid
FL0015594400Medicaid