Healthcare Provider Details

I. General information

NPI: 1568166718
Provider Name (Legal Business Name): NISHANT GOGNA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 SW 16TH ST
GAINESVILLE FL
32608-1128
US

IV. Provider business mailing address

2858 OVERLOOK CT
ATLANTA GA
30324-7503
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-5911
  • Fax:
Mailing address:
  • Phone: 407-620-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number110872
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: