Healthcare Provider Details

I. General information

NPI: 1063805893
Provider Name (Legal Business Name): DANIEL JAMES GILLESPIE AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N LURING DR STE D
PALM SPRINGS CA
92262-6840
US

IV. Provider business mailing address

160 N LURING DR STE D
PALM SPRINGS CA
92262-6840
US

V. Phone/Fax

Practice location:
  • Phone: 408-341-9606
  • Fax: 866-811-0333
Mailing address:
  • Phone: 760-209-6480
  • Fax: 866-811-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number686932-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95235674
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307616-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95026743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: