Provider Demographics
NPI:1245653153
Name:GILLILAND, JOVAN NICOLE (ARNP)
Entity type:Individual
Prefix:
First Name:JOVAN
Middle Name:NICOLE
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOVAN
Other - Middle Name:N
Other - Last Name:CULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 N ASHLEY DR
Mailing Address - Street 2:SUITE 1625
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4300
Mailing Address - Country:US
Mailing Address - Phone:813-417-0633
Mailing Address - Fax:
Practice Address - Street 1:3100 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-493-0243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9283432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily