MEDICARE: JESSICA SUE GELLADY ALALOF 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	363L00000X	Nurse Practitioner	ARNP 9224726	FL

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	:	1396006664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SUE GELLADY ALALOF ARNP

Provider Business Mailing Address
First Line	:	4738 GRAND BLVD
Second Line	:	SUITE C
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5170
Country	:	US
Telephone Number	:	727-807-7800
Fax Number	:	727-807-7878

Provider Business Practice Location Address
First Line	:	4738 GRAND BLVD
Second Line	:	SUITE C
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-5170
Country	:	US
Telephone Number	:	727-807-7800
Fax Number	:	727-807-7878

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

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	12/29/2022

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