Healthcare Provider Details

I. General information

NPI: 1538651419
Provider Name (Legal Business Name): CARRIE ANN GANN DNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 5TH ST S
ST PETERSBURG FL
33701-4804
US

IV. Provider business mailing address

812 CARMEL CV
COLLIERVILLE TN
38017-1359
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-7451
  • Fax:
Mailing address:
  • Phone: 901-550-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number24253
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11001734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: