Healthcare Provider Details

I. General information

NPI: 1225415847
Provider Name (Legal Business Name): DANA GWALTNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2188 58TH ST N
CLEARWATER FL
33760-3112
US

IV. Provider business mailing address

4024 CENTRAL AVE ROOM 200
ST PETERSBURG FL
33711-1239
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-7656
  • Fax: 727-322-2110
Mailing address:
  • Phone: 727-327-7656
  • Fax: 727-322-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9294783
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: