Provider Demographics
NPI:1184173692
Name:GILL, BRIANNE I (MA)
Entity type:Individual
Prefix:MRS
First Name:BRIANNE
Middle Name:
Last Name:GILL
Suffix:I
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E COLONIAL DR
Mailing Address - Street 2:SUITE 390
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4650
Mailing Address - Country:US
Mailing Address - Phone:407-504-1869
Mailing Address - Fax:
Practice Address - Street 1:612 E COLONIAL DR
Practice Address - Street 2:SUITE 390
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4650
Practice Address - Country:US
Practice Address - Phone:407-504-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 14774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health