Provider Demographics
NPI:1154342673
Name:CRAIG, GWENDOLYN DANIELS (ARNP)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:DANIELS
Last Name:CRAIG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5998
Mailing Address - Country:US
Mailing Address - Phone:813-684-6000
Mailing Address - Fax:813-643-2836
Practice Address - Street 1:635 EICHENFELD DR
Practice Address - Street 2:BAY AREA CARDIOLOGY
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5908
Practice Address - Country:US
Practice Address - Phone:813-684-6000
Practice Address - Fax:813-643-2836
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1187122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health