Provider Demographics
NPI:1649755075
Name:FONTES, GILCLEITON (FNP-C)
Entity Type:Individual
Prefix:
First Name:GILCLEITON
Middle Name:
Last Name:FONTES
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 S HAMPTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-2363
Mailing Address - Country:US
Mailing Address - Phone:214-330-9221
Mailing Address - Fax:
Practice Address - Street 1:2701 S HAMPTON RD STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-2363
Practice Address - Country:US
Practice Address - Phone:214-330-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily