Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 11002544 | FL |
Y | 363L00000X | Nurse Practitioner | APRN11002544 | FL |
NPI | 1104485713 |
---|---|
Provider Name | Mrs. Celsey Jae Gurley |
First Address | Clearwater, FL 33761-1510 |
Second Address | Clearwater, FL 33761-1510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2019 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108406900 | (05) | FL |