Provider Demographics
NPI:1497458533
Name:GELLINGER, CONNIE MARIE (APRN CNM)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:GELLINGER
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 OLD WOLF BAY RD
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6816
Mailing Address - Country:US
Mailing Address - Phone:386-597-1396
Mailing Address - Fax:
Practice Address - Street 1:7000 OLD WOLF BAY RD
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6816
Practice Address - Country:US
Practice Address - Phone:386-597-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11487552367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife