Provider Demographics
NPI:1306022744
Name:GUNN, JAN MARIA (MS)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MARIA
Last Name:GUNN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:MARIA
Other - Last Name:GUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MH9798
Mailing Address - Street 1:510 VONDERBURG DR STE 301
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6072
Mailing Address - Country:US
Mailing Address - Phone:813-881-1000
Mailing Address - Fax:813-689-2856
Practice Address - Street 1:501 VONDERBURG DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-881-1000
Practice Address - Fax:813-689-2856
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health