Healthcare Provider Details

I. General information

NPI: 1528215639
Provider Name (Legal Business Name): GILLIOM AUDIOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 ART MUSEUM DR
JACKSONVILLE FL
32207-2596
US

IV. Provider business mailing address

2051 ART MUSEUM DR
JACKSONVILLE FL
32207-2596
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-3323
  • Fax: 904-399-3360
Mailing address:
  • Phone: 904-399-3323
  • Fax: 904-399-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY741
License Number StateFL

VIII. Authorized Official

Name: DR. NANCY GILLIOM
Title or Position: PRESIDENT
Credential:
Phone: 904-399-3323