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General NPI Number Information
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NPI Number | 1568793297
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Entity Type | Individual
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Provider Name | ALICIA GAMBLE MCLOONE PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 785 PRIMERA BLVD SUITE# 1031
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City | LAKE MARY
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State | FL
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Zip | 32746-2124
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Country | US
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Telephone | 407-834-8111
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Fax | 407-708-1985
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Provider Business Mailing Address
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Address Line | 785 PRIMERA BLVD SUITE# 1031
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City | LAKE MARY
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State | FL
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Zip | 32746-2124
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Country | US
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Telephone | 407-834-8111
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Fax | 407-708-1985
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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 | PA9105190
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License Number State | FL
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