Provider Demographics
NPI:1275603441
Name:ARTHURS MOULTON, GILLY SANDRADINE (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:GILLY
Middle Name:SANDRADINE
Last Name:ARTHURS MOULTON
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:GILLY
Other - Middle Name:
Other - Last Name:ARTHURS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:27637 US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-9033
Mailing Address - Country:US
Mailing Address - Phone:352-326-6001
Mailing Address - Fax:352-315-0235
Practice Address - Street 1:27637 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-9033
Practice Address - Country:US
Practice Address - Phone:352-326-6001
Practice Address - Fax:352-315-0235
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021813363LF0000X
FL110218363L00000X
NYF333364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY333364OtherLICENSE