Healthcare Provider Details

I. General information

NPI: 1598771545
Provider Name (Legal Business Name): MICHAEL CLAY GILHOOLY ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S WATER ST
STARKE FL
32091-4511
US

IV. Provider business mailing address

PO BOX 100371
GAINESVILLE FL
32610-0371
US

V. Phone/Fax

Practice location:
  • Phone: 904-368-2480
  • Fax: 904-368-2481
Mailing address:
  • Phone: 352-338-2195
  • Fax: 352-265-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1947072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: