Healthcare Provider Details

I. General information

NPI: 1942827969
Provider Name (Legal Business Name): STEPHEN ERIC GILLIARD APRN-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE STE 9118
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

200 AVENUE F NE STE 9118
WINTER HAVEN FL
33881-4131
US

V. Phone/Fax

Practice location:
  • Phone: 863-292-4004
  • Fax: 863-292-4005
Mailing address:
  • Phone: 863-292-4004
  • Fax: 863-292-4653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11007568
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11007538
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: