Provider Demographics
NPI:1396783031
Name:GILLIOM, NANCY ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANNE
Last Name:GILLIOM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 ART MUSEUM DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2596
Mailing Address - Country:US
Mailing Address - Phone:904-399-3323
Mailing Address - Fax:904-399-3360
Practice Address - Street 1:2051 ART MUSEUM DR
Practice Address - Street 2:SUITE 130
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2596
Practice Address - Country:US
Practice Address - Phone:904-399-3323
Practice Address - Fax:904-399-3360
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY000741231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS1412Medicare ID - Type UnspecifiedAUDIOLOGICAL SERVICES