Provider Demographics
NPI:1467429142
Name:PERRY, GAYLE E (CRNA)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:E
Last Name:PERRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3766 ROSCOMMON DR
Mailing Address - Street 2:PMB 190
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2849
Mailing Address - Country:US
Mailing Address - Phone:407-782-2474
Mailing Address - Fax:
Practice Address - Street 1:3766 ROSCOMMON DR
Practice Address - Street 2:PMB 190
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-2849
Practice Address - Country:US
Practice Address - Phone:407-782-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3417112367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered