Healthcare Provider Details

I. General information

NPI: 1205614112
Provider Name (Legal Business Name): KIMBERLY MARIE GALLO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # D1-211
GAINESVILLE FL
32610-4449
US

IV. Provider business mailing address

PO BOX 100264
GAINESVILLE FL
32610-0264
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5199
  • Fax: 352-392-6781
Mailing address:
  • Phone: 352-273-5199
  • Fax: 352-392-6781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11028277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: