MEDICARE: MRS. JOAN MORRISSEY GAUTREAU ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	ARNP9190624	FL
2	363LF0000X	Family Nurse Practitioner	ARNP 9190624	FL
3	363LP0200X	Pediatric Nurse Practitioner	7233	CA
4	363LF0000X	Family Nurse Practitioner	7233	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154420750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN MORRISSEY GAUTREAU ARNP

Provider Business Mailing Address
First Line	:	9025 SW SAWGRASS WAY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-4105
Country	:	US
Telephone Number	:	772-486-5174
Fax Number	:

Provider Business Practice Location Address
First Line	:	3573 SW CORPORATE PKWY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-8153
Country	:	US
Telephone Number	:	772-283-5431
Fax Number	:	772-283-5471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	01/04/2013

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