Provider Demographics
NPI:1295872083
Name:GAVAN, ROSEMARY (ARNP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:GAVAN
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 1:2020 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4118
Mailing Address - Country:US
Mailing Address - Phone:352-861-0440
Mailing Address - Fax:321-843-4101
Practice Address - Street 1:808 HIGHWAY 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3918
Practice Address - Country:US
Practice Address - Phone:352-751-0040
Practice Address - Fax:352-751-2825
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1376272208800000X
FLARNP1376272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001250200Medicaid
FLE5210VMedicare PIN