Provider Demographics
NPI:1992181929
Name:CAMARGO, KATIE GILLMAN (APRN CNM)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:GILLMAN
Last Name:CAMARGO
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 W NEWBERRY RD.
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-3332
Mailing Address - Fax:352-331-3320
Practice Address - Street 1:6440 W NEWBERRY RD.
Practice Address - Street 2:SUITE 111
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-3332
Practice Address - Fax:352-331-3320
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9354872363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015821100Medicaid