MEDICARE: GAIL DEANNE ROTH ARNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	ARNP9233626	FL

General Provider Information

NPI Number	:	1003332313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL DEANNE ROTH ARNP-C

Provider Business Mailing Address
First Line	:	4604 BROWNWOOD CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1118
Country	:	US
Telephone Number	:	813-679-4101
Fax Number	:

Provider Business Practice Location Address
First Line	:	4604 BROWNWOOD CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1118
Country	:	US
Telephone Number	:	813-679-4101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	07/21/2022

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