Healthcare Provider Details

I. General information

NPI: 1912638073
Provider Name (Legal Business Name): ANTOINE GAVIN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N BYRON BUTLER PKWY
PERRY FL
32347-2300
US

IV. Provider business mailing address

135 QUARTERMAN RD
QUINCY FL
32351-4994
US

V. Phone/Fax

Practice location:
  • Phone: 850-815-5925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11020343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: