Healthcare Provider Details

I. General information

NPI: 1538966759
Provider Name (Legal Business Name): DARIUS DESHAWN GASKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 HIGHWAY 17 STE 1
GREEN COVE SPRINGS FL
32043-9309
US

IV. Provider business mailing address

1157 CLAY ST
FLEMING ISLAND FL
32003-9310
US

V. Phone/Fax

Practice location:
  • Phone: 904-988-6046
  • Fax:
Mailing address:
  • Phone: 904-929-5382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number104557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: