Provider Demographics
NPI:1396279121
Name:GAMBLE-HARRELL, LATRENA TYREE (MSN,FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LATRENA
Middle Name:TYREE
Last Name:GAMBLE-HARRELL
Suffix:
Gender:F
Credentials:MSN,FNP-C
Other - Prefix:PROF
Other - First Name:LATRENA
Other - Middle Name:T
Other - Last Name:GAMBLE-HARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:13670 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3532
Mailing Address - Country:US
Mailing Address - Phone:727-593-9848
Mailing Address - Fax:
Practice Address - Street 1:13670 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3532
Practice Address - Country:US
Practice Address - Phone:727-593-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9309241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109331900Medicaid