Healthcare Provider Details

I. General information

NPI: 1962227074
Provider Name (Legal Business Name): GASNER RANCY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SE 14TH AVE
PORTLAND OR
97214-2569
US

IV. Provider business mailing address

3401 TURTLE CV
WEST PALM BEACH FL
33411-6473
US

V. Phone/Fax

Practice location:
  • Phone: 561-201-8454
  • Fax: 971-339-4913
Mailing address:
  • Phone: 561-201-8454
  • Fax: 971-339-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11036220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: