Healthcare Provider Details

I. General information

NPI: 1679765879
Provider Name (Legal Business Name): ANNE B GIELISSE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 PALM HARBOR BLVD #64
PALM HARBOR FL
34683-2628
US

IV. Provider business mailing address

2242 PALM HARBOR BLVD #64
PALM HARBOR FL
34683-2628
US

V. Phone/Fax

Practice location:
  • Phone: 727-916-0567
  • Fax: 727-784-7318
Mailing address:
  • Phone: 727-916-0567
  • Fax: 727-784-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberARNP 1725562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: