MEDICARE: MRS. GABRIELLA GAGLIARDO

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	363L00000X	Nurse Practitioner	F05240125	FL

General Provider Information

NPI Number	:	1184468613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GABRIELLA GAGLIARDO

Provider Business Mailing Address
First Line	:	1456 SW GILROY RD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1456 SW GILROY RD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2519
Country	:	US
Telephone Number	:	772-204-6831
Fax Number	:

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/20/2024

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