Provider Demographics
NPI:1831953553
Name:GORDON, ANNMARIE
Entity type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 17TH WAY S APT D
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-5148
Mailing Address - Country:US
Mailing Address - Phone:727-851-8207
Mailing Address - Fax:
Practice Address - Street 1:5511 17TH WAY S APT D
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-5148
Practice Address - Country:US
Practice Address - Phone:727-851-8207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health