Provider Demographics
NPI:1760037105
Name:GACHOKA, SHEILA WARUGURU
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:WARUGURU
Last Name:GACHOKA
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 1:3649 30TH AVE N APT 7
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-3524
Mailing Address - Country:US
Mailing Address - Phone:305-986-7806
Mailing Address - Fax:
Practice Address - Street 1:26606 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-8545
Practice Address - Country:US
Practice Address - Phone:813-907-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104287700Medicaid