Provider Demographics
NPI:1265761332
Name:GWYN, PRISCILLA GAGE (PHD, ARNP-BC, OCN)
Entity type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:GAGE
Last Name:GWYN
Suffix:
Gender:F
Credentials:PHD, ARNP-BC, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 286
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4675
Mailing Address - Country:US
Mailing Address - Phone:407-303-2770
Mailing Address - Fax:407-303-3268
Practice Address - Street 1:2501 N ORANGE AVE STE 286
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4675
Practice Address - Country:US
Practice Address - Phone:407-303-2770
Practice Address - Fax:407-303-3268
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2697812363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP129200001Medicare UPIN