Provider Demographics
NPI:1427693415
Name:GUMBS, ERIK
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:GUMBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ERIQUE
Other - Middle Name:
Other - Last Name:GUMBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:11 BLACKBIRD CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-8633
Mailing Address - Country:US
Mailing Address - Phone:302-229-2976
Mailing Address - Fax:
Practice Address - Street 1:805 RIVER RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3753
Practice Address - Country:US
Practice Address - Phone:303-857-5060
Practice Address - Fax:302-857-5061
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0000324363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELP-0000324OtherSTATE OF DELAWARE LICENSE
AG05190078OtherTHE AMERICAN ASSOCIATION OF NURSE PRACTITIONERS