Healthcare Provider Details

I. General information

NPI: 1598230179
Provider Name (Legal Business Name): DINA GEHRKE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DINA LOBEL MS

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 DELTONA BLVD STE A
DELTONA FL
32725-8016
US

IV. Provider business mailing address

12652 CASTLE HILL DR
TAMPA FL
33624-4177
US

V. Phone/Fax

Practice location:
  • Phone: 813-509-6868
  • Fax:
Mailing address:
  • Phone: 813-509-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: