Provider Demographics
NPI:1336600931
Name:GILLILAND, LINDA LOUISE (PHD, APRN)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:LOUISE
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N NEW YORK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3103
Mailing Address - Country:US
Mailing Address - Phone:407-765-6227
Mailing Address - Fax:
Practice Address - Street 1:601 N NEW YORK AVE STE 101
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3103
Practice Address - Country:US
Practice Address - Phone:407-765-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2515902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner