Provider Demographics
NPI:1942827969
Name:GILLIARD, STEPHEN ERIC (APRN-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ERIC
Last Name:GILLIARD
Suffix:
Gender:M
Credentials:APRN-C
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Mailing Address - Street 1:200 AVENUE F NE STE 9118
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4131
Mailing Address - Country:US
Mailing Address - Phone:863-292-4004
Mailing Address - Fax:863-292-4653
Practice Address - Street 1:200 AVENUE F NE STE 9118
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-292-4004
Practice Address - Fax:863-292-4005
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11007568363LA2100X
FLAPRN11007538363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109323700Medicaid