Healthcare Provider Details

I. General information

NPI: 1104248251
Provider Name (Legal Business Name): DEBORAH LYNN GILMORE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 MAR WALT DRIVE PULMONOLOGY DEPARTMENT
FORT WALTON BEACH FL
32547-6796
US

IV. Provider business mailing address

1005 MAR WALT DRIVE PULMONOLOGY DEPARTMENT
FORT WALTON BEACH FL
32547-6796
US

V. Phone/Fax

Practice location:
  • Phone: 850-243-0118
  • Fax: 850-243-0594
Mailing address:
  • Phone: 850-243-0118
  • Fax: 850-243-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9213456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: