Provider Demographics
NPI:1891745055
Name:EZELL, GAIL MARIE (MSN,RN,CPNP,ARNP)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:MARIE
Last Name:EZELL
Suffix:
Gender:F
Credentials:MSN,RN,CPNP,ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 WEKIVA SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3607
Mailing Address - Country:US
Mailing Address - Phone:321-280-5867
Mailing Address - Fax:407-774-1877
Practice Address - Street 1:357 WEKIVA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3607
Practice Address - Country:US
Practice Address - Phone:321-280-5867
Practice Address - Fax:407-774-1877
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9328363363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425769700Medicaid
FL0039996800Medicaid
MO425769700Medicaid
MO269B558Medicare ID - Type Unspecified