Provider Demographics
NPI:1265047740
Name:GATLIN, AMY BALL (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BALL
Last Name:GATLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ALISON
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 HICKORY CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8009
Mailing Address - Country:US
Mailing Address - Phone:214-533-3777
Mailing Address - Fax:
Practice Address - Street 1:3012 N US HIGHWAY 301 STE 1000
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-2208
Practice Address - Country:US
Practice Address - Phone:813-542-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9447676163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse