Healthcare Provider Details

I. General information

NPI: 1508613787
Provider Name (Legal Business Name): THERESA GAGLIARDO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N COURTENAY PKWY STE 100
MERRITT ISLAND FL
32953-4127
US

IV. Provider business mailing address

2400 N COURTENAY PKWY STE 100
MERRITT ISLAND FL
32953-4127
US

V. Phone/Fax

Practice location:
  • Phone: 321-985-9097
  • Fax: 321-301-4869
Mailing address:
  • Phone: 321-985-9097
  • Fax: 321-301-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11031826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: