Healthcare Provider Details

I. General information

NPI: 1619829181
Provider Name (Legal Business Name): DAVID ALLEN GILL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ERIE ST
EDINBORO PA
16412-2200
US

IV. Provider business mailing address

182 CONSTITUTION AVE
BRADFORD PA
16701-1505
US

V. Phone/Fax

Practice location:
  • Phone: 814-734-1618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number358969
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP035851
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: