Individual provider Active NPI

Jessica Lanette Gapusan

  • Family Nurse Practitioner
  • Pensacola, FL
National Provider Identifier
1992573406
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11030155 Issued in FL
Practice address
5111 N 12TH Ave
Pensacola, FL 32504-8918
Phone
(904) 309-2383
NPI assigned
Dec 13, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11030155 FL Primary

Addresses

Primary practice location

5111 N 12TH Ave
Pensacola, FL 32504-8918

Mailing address

1112 Black Walnut TRL
Pensacola, FL 32514-1916
Phone (904) 309-2383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231228003412 FL Practitioner - Nurse Practitioner 2961852264 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11030155FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wound Management Specialists, LLC CurrentSince Mar 1, 2025 Accepting new patients

Locations

778 Liberty Rd
Flowood, MS 39232
Phone (601) 914-9620

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1702425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1992573406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 BLACK WALNUT TRL",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325141916",
            "telephone_number": "904-309-2383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5111 N 12TH AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048918",
            "telephone_number": "904-309-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAPUSAN",
        "first_name": "JESSICA",
        "middle_name": "LANETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-13",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11030155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.