| Doctor Name: | MR. GERRY SURRENCY |
| NPI Number: | 1457771016 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PMHNP-BC, ARNP |
| License Number: | ARNP3174792 |
| Business Practice Address: | 7765 S County Road 231 Lake Butler, FL - 320545721 |
| Business Phone Number: | 3864966000 |
| Business Fax Number: | |
| Mailing Address: | Po Box 628, LAKE BUTLER |
| State: | FL |
| Postal Code: | 320540628 |
| Phone Number: | 3864966000 |
| Fax Number: | |
| NPI Enumeration Date: | 04/22/2014 |
| NPI Last Update Date: | 10/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | ARNP3174792 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |