Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | RN9335226 | FL |
Y | 363L00000X | Nurse Practitioner | APRN11004910 | FL |
N | 363L00000X | Nurse Practitioner | RN9335226 | FL |
NPI | 1336792829 |
---|---|
Provider Name | Graciela Teresita Gallo |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2019 |
Last Update Date | 19/11/2019 |