MEDICARE: SONYA GILMORE

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	163WC0200X	Critical Care Medicine Registered Nurse	3150532	FL
2	363LF0000X	Family Nurse Practitioner	AP61563104	WA
3	363LF0000X	Family Nurse Practitioner	11006792	FL

General Provider Information

NPI Number	:	1992338636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYA GILMORE

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 CLOVERDALE BLVD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1405
Country	:	US
Telephone Number	:	850-862-7604
Fax Number	:

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	09/06/2024

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Directions to “ SONYA GILMORE ” Practice Location

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