MEDICARE: KATHLY MARIE JEAN-GILLES A.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9212083	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y086H	OTHER	FL	FLORIDA BLUE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700866068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLY MARIE JEAN-GILLES A.R.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 417
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34995-0417
Country	:	US
Telephone Number	:	772-223-2832
Fax Number	:	772-223-5653

Provider Business Practice Location Address
First Line	:	200 SE HOSPITAL AVE
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-2346
Country	:	US
Telephone Number	:	772-223-2618
Fax Number	:	772-288-5834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	03/17/2018

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