Individual provider Active NPI

Gabrielle Mai, APRN

  • Pediatric Nurse Practitioner
  • Lutz, FL
National Provider Identifier
1487170460
Registry record updated Jun 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
APRN11001110 Issued in FL
Practice address
1854 Oak Grove Blvd
Lutz, FL 33559-8605
Phone
(813) 948-6133
Fax
(813) 948-1258
NPI assigned
Aug 21, 2017
Last updated
Jun 26, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 209.016283 IL
Pediatric Nurse Practitioner 363LP0200X APRN11001110 FL Primary

Addresses

Primary practice location

1854 Oak Grove Blvd
Lutz, FL 33559-8605

Mailing address

4033 Tampa Rd Ste 101
Oldsmar, FL 34677-3224
Phone (813) 854-2003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11001110FLMDPediatric Nurse Practitioner
209.016283ILMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Health Care Alliance, PA CurrentSince Aug 28, 2021 Accepting new patients
Pediatric Health Care Alliance, PA PastSince Jun 28, 2020 Accepting new patients
Lurie Children's Medical Group, LLC Past Accepting new patients

Locations

1854 Oak Grove Blvd
Lutz, FL 33559
Phone (813) 471-9709

4033 Tampa Rd
Ste 101
Oldsmar, FL 34677
Phone (813) 854-2003

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593129600000",
    "number": "1487170460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4033 TAMPA RD STE 101",
            "city": "OLDSMAR",
            "state": "FL",
            "postal_code": "346773224",
            "telephone_number": "813-854-2003",
            "fax_number": "813-436-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1854 OAK GROVE BLVD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335598605",
            "telephone_number": "813-948-6133",
            "fax_number": "813-948-1258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAI",
        "first_name": "GABRIELLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-21",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209.016283",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "APRN11001110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutz, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.