Provider Demographics
NPI:1639462070
Name:QUEEN, GILLIAN L (ARNP)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:L
Last Name:QUEEN
Suffix:
Gender:F
Credentials:ARNP
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 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-4970
Mailing Address - Fax:850-416-4969
Practice Address - Street 1:5153 N 9TH AVE
Practice Address - Street 2:STE 404
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-416-4970
Practice Address - Fax:850-416-4969
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9321833363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFD508ZMedicare PIN