Healthcare Provider Details

I. General information

NPI: 1972283224
Provider Name (Legal Business Name): DARNELLE GILLOT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 STOCKTON DR
TOMS RIVER NJ
08755-6433
US

IV. Provider business mailing address

5032 WHITAKER AVE
PHILADELPHIA PA
19124-3515
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-6655
  • Fax:
Mailing address:
  • Phone: 215-307-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14871100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: