Healthcare Provider Details

I. General information

NPI: 1326445321
Provider Name (Legal Business Name): CHRISTINE GAYLORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 N JEFFERSON ST
JACKSONVILLE FL
32209-6525
US

IV. Provider business mailing address

2933 RAVINE HILL DR
MIDDLEBURG FL
32068-1711
US

V. Phone/Fax

Practice location:
  • Phone: 904-475-5800
  • Fax:
Mailing address:
  • Phone: 904-382-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number9163286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: