Healthcare Provider Details

I. General information

NPI: 1992451520
Provider Name (Legal Business Name): MADELINE GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 W SWANN AVE STE 100
TAMPA FL
33606-2478
US

IV. Provider business mailing address

307 INTERNATIONAL CIR STE 100
HUNT VALLEY MD
21030-1387
US

V. Phone/Fax

Practice location:
  • Phone: 813-251-1618
  • Fax:
Mailing address:
  • Phone: 410-667-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2830997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: