Healthcare Provider Details

I. General information

NPI: 1669303798
Provider Name (Legal Business Name): MAGGIE LEIGH GURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 N COVE BLVD
PANAMA CITY FL
32401-3642
US

IV. Provider business mailing address

619 N COVE BLVD
PANAMA CITY FL
32401-3642
US

V. Phone/Fax

Practice location:
  • Phone: 850-270-8411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-539787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: