Healthcare Provider Details

I. General information

NPI: 1104933563
Provider Name (Legal Business Name): GAYLE G WOLFE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

IV. Provider business mailing address

15418 N 15TH ST
LUTZ FL
33549-3519
US

V. Phone/Fax

Practice location:
  • Phone: 813-228-2761
  • Fax: 813-225-7048
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberARNP2036412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: