Provider Demographics
NPI:1518536135
Name:GOTAY, MAFLORENCE B
Entity Type:Individual
Prefix:
First Name:MAFLORENCE
Middle Name:B
Last Name:GOTAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MA FLORENCE
Other - Middle Name:B
Other - Last Name:GOTAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100254
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-4837
Mailing Address - Country:US
Mailing Address - Phone:352-273-6575
Mailing Address - Fax:352-273-8612
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-7461
Practice Address - Country:US
Practice Address - Phone:352-273-8610
Practice Address - Fax:352-273-8612
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9368679163W00000X
FL11021040367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UNKNOWNOtherUNKNOWN
FL116091800Medicaid