Provider Demographics
NPI:1699517896
Name:GUMMERSALL, FLOYD RANDEL (RN)
Entity type:Individual
Prefix:
First Name:FLOYD
Middle Name:RANDEL
Last Name:GUMMERSALL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HEADSTART WAY
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-9764
Mailing Address - Country:US
Mailing Address - Phone:307-371-4843
Mailing Address - Fax:307-371-4843
Practice Address - Street 1:400 HEADSTART WAY
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-9764
Practice Address - Country:US
Practice Address - Phone:307-371-4843
Practice Address - Fax:307-371-4843
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program