Provider Demographics
NPI:1780572586
Name:HARVEST MEDICAL SERVICES
Entity type:Organization
Organization Name:HARVEST MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONGORA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-810-8650
Mailing Address - Street 1:12807 HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4407
Mailing Address - Country:US
Mailing Address - Phone:813-810-8650
Mailing Address - Fax:
Practice Address - Street 1:12807 HORSESHOE RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4407
Practice Address - Country:US
Practice Address - Phone:813-810-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty