Provider Demographics
NPI:1578985792
Name:GASKINS, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GASKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 AMBROSE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-4709
Mailing Address - Country:US
Mailing Address - Phone:844-673-6968
Mailing Address - Fax:844-673-6968
Practice Address - Street 1:6500 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4392
Practice Address - Country:US
Practice Address - Phone:844-673-6968
Practice Address - Fax:844-673-6968
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2619722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2619722OtherMEDICAL LICENSE
FLN/AMedicaid
FLN/AMedicaid