Healthcare Provider Details

I. General information

NPI: 1306772702
Provider Name (Legal Business Name): ANGELA GAMBINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6132 KRISTA DR
SPRING HILL FL
34609-8955
US

IV. Provider business mailing address

6132 KRISTA DR
SPRING HILL FL
34609-8955
US

V. Phone/Fax

Practice location:
  • Phone: 570-401-5407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11048863
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number767416
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: