Healthcare Provider Details

I. General information

NPI: 1467147389
Provider Name (Legal Business Name): BRIANA NICOLE GORMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 2ND AVE SW
LARGO FL
33770-2298
US

IV. Provider business mailing address

1839 CENTRAL AVE
ST PETERSBURG FL
33713-8900
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-7706
  • Fax: 727-588-9478
Mailing address:
  • Phone: 727-322-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11025688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: