Basic Information
| Provider Information | |||||||||
| NPI: | 1760037105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GACHOKA | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | WARUGURU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3649 30TH AVE N APT 7 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337133524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059867806 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26606 MAGNOLIA BLVD | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335598545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139070123 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2019 | ||||||||
| LastUpdateDate: | 03/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN11003016 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 104287700 | 05 | FL | MEDICAID |