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General NPI Number Information
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NPI Number | 1114144995
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Entity Type | Individual
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Provider Name | GAYLE SHUFORD NICULA ARNP
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 1550 S WATER ST
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City | STARKE
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State | FL
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Zip | 32091-4511
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Country | US
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Telephone | 904-368-2480
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Fax | 904-368-2484
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Provider Business Mailing Address
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Address Line | 1550 S WATER ST
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City | STARKE
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State | FL
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Zip | 32091-4511
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Country | US
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Telephone | 904-368-2480
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Fax | 904-368-2484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP1275408
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License Number State | FL
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