Provider Demographics
NPI:1760914907
Name:GAINES, ZULLY M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ZULLY
Middle Name:M
Last Name:GAINES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:ZULLY
Other - Middle Name:M
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3550 ESPLANADE WAY APT 4307
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3762
Mailing Address - Country:US
Mailing Address - Phone:321-948-4988
Mailing Address - Fax:
Practice Address - Street 1:315 E ASH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2029
Practice Address - Country:US
Practice Address - Phone:850-584-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9333411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily