Healthcare Provider Details

I. General information

NPI: 1366303968
Provider Name (Legal Business Name): DEIDRA JEAN GALLAGHER MSN-PH, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3389 SHERIDAN ST STE 525
HOLLYWOOD FL
33021-3606
US

IV. Provider business mailing address

3389 SHERIDAN ST STE 525
HOLLYWOOD FL
33021-3606
US

V. Phone/Fax

Practice location:
  • Phone: 561-399-4900
  • Fax:
Mailing address:
  • Phone: 561-399-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9367753
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11046576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: