Healthcare Provider Details

I. General information

NPI: 1467089557
Provider Name (Legal Business Name): SHAUN COREY GAMSE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 S FLORIDA AVE
LAKELAND FL
33813-2510
US

IV. Provider business mailing address

5010 S FLORIDA AVE
LAKELAND FL
33813-2510
US

V. Phone/Fax

Practice location:
  • Phone: 863-644-2411
  • Fax: 863-607-4727
Mailing address:
  • Phone: 863-644-2411
  • Fax: 863-607-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: