Healthcare Provider Details

I. General information

NPI: 1790753028
Provider Name (Legal Business Name): NEVIN A. GORKI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 S TAMIAMI TRL SUITE 303
SARASOTA FL
34239-2930
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4093
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8791
  • Fax: 941-917-8793
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: