Provider Demographics
NPI:1528698586
Name:GAMENG, KARIN JEANINE
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:JEANINE
Last Name:GAMENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3303
Mailing Address - Country:US
Mailing Address - Phone:850-264-6502
Mailing Address - Fax:
Practice Address - Street 1:2410 MAHAN DR STE 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-2305
Practice Address - Country:US
Practice Address - Phone:850-656-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9309628163W00000X
FLAPRN11005741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse