Provider Demographics
NPI:1164792602
Name:RATHBUN, GAIL LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LEE
Last Name:RATHBUN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:LEE
Other - Last Name:GOETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6311 S. POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MEYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-275-0040
Mailing Address - Fax:239-275-7997
Practice Address - Street 1:6311 S. POINTE BLVD.
Practice Address - Street 2:
Practice Address - City:FORT MEYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-275-0040
Practice Address - Fax:239-275-7997
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9275512363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner