Healthcare Provider Details

I. General information

NPI: 1518515089
Provider Name (Legal Business Name): JOSEPH MICHAEL GULLETT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD RM G-901
GAINESVILLE FL
32610-1135
US

IV. Provider business mailing address

1600 SW ARCHER RD RM G-901
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0294
  • Fax:
Mailing address:
  • Phone: 352-265-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: