Provider Demographics
NPI:1104059120
Name:DAVENPORT, GAIL LYNN (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:LYNN
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4708
Mailing Address - Country:US
Mailing Address - Phone:727-893-6234
Mailing Address - Fax:727-553-7798
Practice Address - Street 1:6017TH ST S
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4748
Practice Address - Country:US
Practice Address - Phone:727-893-6234
Practice Address - Fax:727-553-7798
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3351742363L00000X, 363LA2200X
FLARNP3351742363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109410700Medicaid