Healthcare Provider Details

I. General information

NPI: 1992746945
Provider Name (Legal Business Name): DEBORAH GILSTRAP RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 JESSE JEWELL PKWY SE SUITE 300
GAINESVILLE GA
30501-3862
US

IV. Provider business mailing address

6572 OLD CLEVELAND RD
CLERMONT GA
30527-1527
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-7200
  • Fax: 770-536-9800
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN052672
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: