Healthcare Provider Details

I. General information

NPI: 1871472712
Provider Name (Legal Business Name): MASHELL GILLETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 LINCOLN RD
VENICE FL
34293-6811
US

IV. Provider business mailing address

5820 LINCOLN RD
VENICE FL
34293-6811
US

V. Phone/Fax

Practice location:
  • Phone: 517-375-9957
  • Fax:
Mailing address:
  • Phone: 517-375-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95244045
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9488060
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704285739
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11039748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: