Provider Demographics
NPI:1437449592
Name:GILEAD MEDICAL LLC
Entity Type:Organization
Organization Name:GILEAD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:LANEE
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-304-5990
Mailing Address - Street 1:4475 SE 48TH PLACE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-4911
Mailing Address - Country:US
Mailing Address - Phone:352-304-5990
Mailing Address - Fax:352-304-5993
Practice Address - Street 1:1801 SE 24TH RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6073
Practice Address - Country:US
Practice Address - Phone:352-304-5990
Practice Address - Fax:353-304-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9283760363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG395ZMedicare PIN
FLFE614AMedicare PIN