Provider Demographics
NPI:1538287958
Name:GILLETT, CAROL DIANE (ANP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:DIANE
Last Name:GILLETT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1355
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77516
Mailing Address - Country:US
Mailing Address - Phone:281-595-2467
Mailing Address - Fax:281-595-2467
Practice Address - Street 1:3818 COUNTY ROAD 36
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515
Practice Address - Country:US
Practice Address - Phone:281-595-2467
Practice Address - Fax:281-595-2467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX507329363LF0000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167608204Medicaid
TX167608204Medicaid