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General NPI Number Information
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NPI Number | 1366303968
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Entity Type | Individual
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Provider Name | DEIDRA JEAN GALLAGHER RN
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Gender | Female
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Dates
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Enumeration Date | 11/21/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 11300 NE 2ND AVE
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City | MIAMI SHORES
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State | FL
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Zip | 33161-6695
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Country | US
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Telephone | 305-899-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 3389 SHERIDAN ST STE 525
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3606
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Country | US
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Telephone | 561-399-4900
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Fax |
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 9367753
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License Number State | FL
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