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General NPI Number Information
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NPI Number | 1386398113
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Entity Type | Individual
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Provider Name | ERICA GALLUP PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 14550 OLD SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32258-2460
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Country | US
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Telephone | 904-271-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 13803 WHITE HERON PL
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City | JACKSONVILLE
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State | FL
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Zip | 32224-4804
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Country | US
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Telephone | 904-254-6112
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9115514
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License Number State | FL
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