Individual provider Active NPI

Cynthia Gourley, PA-C

  • Surgical Physician Assistant
  • Tampa, FL
National Provider Identifier
1962466490
Registry record updated Jul 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9101235 Issued in FL
Practice address
12880 Commodity PL
Care of United Surgical Assistants, Inc.
Tampa, FL 33626-3101
Phone
(877) 872-5788
Fax
(866) 698-7272
NPI assigned
Apr 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA9101235 FL Primary

Addresses

Primary practice location

12880 Commodity PL
Care of United Surgical Assistants, Inc.
Tampa, FL 33626-3101

Mailing address

PO Box 21686
Care of United Surgical Assistants, Inc.
Tampa, FL 33622-1686

Other identifiers 1

IdentifierTypeStateIssuer
291030600MedicaidFL

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
Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1962466490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21686",
            "address_2": "CARE OF UNITED SURGICAL ASSISTANTS, INC.",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336221686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12880 COMMODITY PL",
            "address_2": "CARE OF UNITED SURGICAL ASSISTANTS, INC.",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336263101",
            "telephone_number": "877-872-5788",
            "fax_number": "866-698-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURLEY",
        "first_name": "CYNTHIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-13",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9101235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291030600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; 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.