MEDICARE: CAITLIN GORMAN APRN

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	363LF0000X	Family Nurse Practitioner	APRN9310527	FL

General Provider Information

NPI Number	:	1356808851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN GORMAN APRN

Provider Business Mailing Address
First Line	:	5813 S 2ND ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-4407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 W AZEELE ST STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3110
Country	:	US
Telephone Number	:	813-219-1876
Fax Number	:

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

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	07/19/2023

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