Healthcare Provider Details

I. General information

NPI: 1396006664
Provider Name (Legal Business Name): JESSICA SUE GELLADY ALALOF ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4738 GRAND BLVD SUITE C
NEW PORT RICHEY FL
34652-5170
US

IV. Provider business mailing address

4738 GRAND BLVD SUITE C
NEW PORT RICHEY FL
34652-5170
US

V. Phone/Fax

Practice location:
  • Phone: 727-807-7800
  • Fax: 727-807-7878
Mailing address:
  • Phone: 727-807-7800
  • Fax: 727-807-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 9224726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: