Provider Demographics
NPI:1699042945
Name:GOUVEIA, MARY ANN (NNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:GOUVEIA
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP-BC
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:813-974-2812
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:813-974-2201
Practice Address - Fax:813-974-2812
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9457263363LN0000X
GARN103886363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA650686OtherWELLCARE
FLKH583OtherMEDICARE
GA003118310AMedicaid
FL0335DOtherBLUE CROSS BLUE SHIELD
FL100978700Medicaid
GA01470759OtherAMERIGROUP