Individual
LAVANYA GOPAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3520 38TH AVE N, ST PETERSBURG, FL 33713
(727) 471-5039
Mailing address
3520 38TH AVE N, ST PETERSBURG, FL 33713-1448
(727) 471-5039
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
9293070
FL
Other
Enumeration date
01/05/2018
Last updated
05/15/2019
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