Healthcare Provider Details

I. General information

NPI: 1558512756
Provider Name (Legal Business Name): SHARON A GILLYARD RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5816 SW ARCHER RD LOT 104
GAINESVILLE FL
32608-3838
US

IV. Provider business mailing address

PO BOX 140512
GAINESVILLE FL
32614-0512
US

V. Phone/Fax

Practice location:
  • Phone: 352-335-2373
  • Fax:
Mailing address:
  • Phone: 352-335-2373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT8583
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: