Healthcare Provider Details

I. General information

NPI: 1598301913
Provider Name (Legal Business Name): HEATHER GILMORE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4866 BIG ISLAND DR
JACKSONVILLE FL
32246-7498
US

IV. Provider business mailing address

321 N HIGHLAND AVE STE 200
SHERMAN TX
75092-7371
US

V. Phone/Fax

Practice location:
  • Phone: 904-652-0652
  • Fax:
Mailing address:
  • Phone: 903-893-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP1058060
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: