Provider Demographics
NPI:1265163596
Name:GILLESPIE, MARIA (FNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 OUTER OCTAGON
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-5602
Mailing Address - Country:US
Mailing Address - Phone:937-789-5709
Mailing Address - Fax:
Practice Address - Street 1:123 STONE OAK LOOP
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3391
Practice Address - Country:US
Practice Address - Phone:210-495-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily