MEDICARE: MARCIA K. GILKES APN

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	363LG0600X	Gerontology Nurse Practitioner	3240662	FL
2	363LP2300X	Primary Care Nurse Practitioner	ARNP3240662	FL

General Provider Information

NPI Number	:	1912195900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA K. GILKES APN

Provider Business Mailing Address
First Line	:	PO BOX 1357
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-1357
Country	:	US
Telephone Number	:	239-278-3600
Fax Number	:	239-278-3203

Provider Business Practice Location Address
First Line	:	3594 BROADWAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8016
Country	:	US
Telephone Number	:	239-344-2330
Fax Number	:	239-332-4701

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

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	11/11/2009

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