Provider Demographics
NPI:1437734340
Name:GUSSMAN, HAROLD III (APRN)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:GUSSMAN
Suffix:III
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3718
Mailing Address - Country:US
Mailing Address - Phone:727-353-3550
Mailing Address - Fax:727-289-2098
Practice Address - Street 1:10560 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3718
Practice Address - Country:US
Practice Address - Phone:727-353-3550
Practice Address - Fax:727-289-2098
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010795363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner