Provider Demographics
NPI:1467682351
Name:GILG GACHIANI, NICOLE JACQLYN (MD,MPH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JACQLYN
Last Name:GILG GACHIANI
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S DALE MABRY HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4400
Mailing Address - Country:US
Mailing Address - Phone:813-548-7860
Mailing Address - Fax:
Practice Address - Street 1:711 S DALE MABRY HWY STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4400
Practice Address - Country:US
Practice Address - Phone:813-548-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-26
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40429207Q00000X
FLME153665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine