Healthcare Provider Details

I. General information

NPI: 1396762019
Provider Name (Legal Business Name): MARJORIE MAY GILLESPIE PH.D., PMHNP,M-CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/12/2025
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 W OAKLAND PARK BLVD STE 214
SUNRISE FL
33351-1126
US

IV. Provider business mailing address

PO BOX 16472
FT LAUDERDALE FL
33318-6472
US

V. Phone/Fax

Practice location:
  • Phone: 954-431-7676
  • Fax: 888-538-2226
Mailing address:
  • Phone: 305-778-3157
  • Fax: 888-538-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2809552
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberARNP2809552
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberARNP2809552
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberARNP2809552
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2809552
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN2809552
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberARNP2809552
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2809552
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2809552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: