Healthcare Provider Details

I. General information

NPI: 1174488209
Provider Name (Legal Business Name): JIA GATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S GOMEZ AVE APT 1
TAMPA FL
33609-4194
US

IV. Provider business mailing address

409 S GOMEZ AVE APT 1
TAMPA FL
33609-4194
US

V. Phone/Fax

Practice location:
  • Phone: 959-200-2267
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number41937
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: