Provider Demographics
NPI:1841917879
Name:GIMINO, ANTHONY F (APRN)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:F
Last Name:GIMINO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11616 LAKE UNDERHILL RD STE 215
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4465
Mailing Address - Country:US
Mailing Address - Phone:407-482-7788
Mailing Address - Fax:407-482-8698
Practice Address - Street 1:11616 LAKE UNDERHILL RD STE 215
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4465
Practice Address - Country:US
Practice Address - Phone:407-482-7788
Practice Address - Fax:407-482-8698
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022467363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology