Provider Demographics
NPI:1245680487
Name:RICKER, GAIL MIRANDA (APRN)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:MIRANDA
Last Name:RICKER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:MRS
Other - First Name:GAIL
Other - Middle Name:MIRANDA
Other - Last Name:GUEVARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1095 US HIGHWAY 82 W
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5803
Mailing Address - Country:US
Mailing Address - Phone:229-800-8102
Mailing Address - Fax:229-800-8101
Practice Address - Street 1:1095 US HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-5803
Practice Address - Country:US
Practice Address - Phone:229-800-8100
Practice Address - Fax:229-800-8101
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-19
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN157942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003180535YMedicaid