Provider Demographics
NPI:1912920596
Name:GALL, JOLENE (ARNP)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:GALL
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W. DR. MARTIN LUTHER KING BLVD.
Mailing Address - Street 2:MAB 3RD FLOOR
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-870-4438
Mailing Address - Fax:813-870-4153
Practice Address - Street 1:3003 W. DR. MARTIN LUTHER KING BLVD.
Practice Address - Street 2:MAB 3RD FLOOR
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-870-4438
Practice Address - Fax:813-870-4153
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2152432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily