Healthcare Provider Details

I. General information

NPI: 1649278979
Provider Name (Legal Business Name): CARMINE GIPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARMINE BLAISE MD

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N BLUFORD AVE
OCOEE FL
34761-2216
US

IV. Provider business mailing address

7400 DOCS GROVE CIR
ORLANDO FL
32819-8010
US

V. Phone/Fax

Practice location:
  • Phone: 888-644-1448
  • Fax: 407-877-2166
Mailing address:
  • Phone: 407-352-9717
  • Fax: 407-354-5425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME76607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: