Healthcare Provider Details

I. General information

NPI: 1104485713
Provider Name (Legal Business Name): CELSEY JAE GURLEY APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CELSEY GURLEY

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29750 US HIGHWAY 19 N STE 101
CLEARWATER FL
33761-1510
US

IV. Provider business mailing address

29750 US HIGHWAY 19 N STE 101
CLEARWATER FL
33761-1510
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-5058
  • Fax: 813-635-2639
Mailing address:
  • Phone: 727-786-5058
  • Fax: 813-635-2639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11002544
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: