Provider Demographics
NPI:1952457483
Name:GAFFKA, ANN (ARNP-C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:GAFFKA
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5763 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4703
Mailing Address - Country:US
Mailing Address - Phone:386-295-3512
Mailing Address - Fax:386-222-7376
Practice Address - Street 1:5763 STEWART AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4703
Practice Address - Country:US
Practice Address - Phone:386-295-3512
Practice Address - Fax:386-222-7376
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3057822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3057822OtherLICENSE
FLARNP3057822OtherLICENSE