Provider Demographics
NPI:1003362211
Name:GILLESPIE, JEANETTE CHRISTINE (RT(R)(CT))
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:CHRISTINE
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:RT(R)(CT)
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:CHRISTINE
Other - Last Name:INGUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1357 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2011
Mailing Address - Country:US
Mailing Address - Phone:727-458-9082
Mailing Address - Fax:
Practice Address - Street 1:1357 HILLSIDE DR.
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-2011
Practice Address - Country:US
Practice Address - Phone:727-458-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT54339247100000X, 2471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist