MEDICARE: DANIELLE GILLESPIE

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	101Y00000X	Counselor	IMT3862	FL

General Provider Information

NPI Number	:	1972298966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE GILLESPIE

Provider Business Mailing Address
First Line	:	12278 SALVIA CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-0840
Country	:	US
Telephone Number	:	904-438-0634
Fax Number	:

Provider Business Practice Location Address
First Line	:	4940 EMERSON ST STE 103
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-4970
Country	:	US
Telephone Number	:	904-323-6801
Fax Number	:

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

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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Directions to “ DANIELLE GILLESPIE ” Practice Location

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