Healthcare Provider Details

I. General information

NPI: 1740937531
Provider Name (Legal Business Name): GISELLA DEJESUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7819 N DALE MABRY HWY STE 108
TAMPA FL
33614-3210
US

IV. Provider business mailing address

7819 N DALE MABRY HWY STE 108
TAMPA FL
33614-3210
US

V. Phone/Fax

Practice location:
  • Phone: 813-538-0149
  • Fax:
Mailing address:
  • Phone: 813-538-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11018433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: