MEDICARE: MRS. DESIREE ELISE GAYLE FNP-BC

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	363L00000X	Nurse Practitioner	AP139622	TX
2	363LF0000X	Family Nurse Practitioner	AP139622	TX

General Provider Information

NPI Number	:	1740747807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DESIREE ELISE GAYLE FNP-BC

Provider Business Mailing Address
First Line	:	8911 N CAPITAL OF TEXAS HWY STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-7247
Country	:	US
Telephone Number	:	877-279-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	8911 N CAPITAL OF TEXAS HWY STE 110
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-7247
Country	:	US
Telephone Number	:	877-279-5960
Fax Number	:

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

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	05/02/2024

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