Healthcare Provider Details

I. General information

NPI: 1861863037
Provider Name (Legal Business Name): MICHAEL GORDON DILLING FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18167 US HIGHWAY 19 N # 337 SUITE 650
CLEARWATER FL
33764-3528
US

IV. Provider business mailing address

3219 CENTERWOOD DR
TARPON SPRINGS FL
34688-7230
US

V. Phone/Fax

Practice location:
  • Phone: 727-507-3600
  • Fax:
Mailing address:
  • Phone: 727-647-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9308938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: