Provider Demographics
NPI:1932730025
Name:GANDARILLAS, JULIO C (APRN-C)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:C
Last Name:GANDARILLAS
Suffix:
Gender:M
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6703 14TH STREET W, SUITE 102
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-5836
Mailing Address - Country:US
Mailing Address - Phone:941-756-1253
Mailing Address - Fax:941-751-0158
Practice Address - Street 1:6703 14TH STREET W, SUITE 102
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5836
Practice Address - Country:US
Practice Address - Phone:941-756-1253
Practice Address - Fax:941-751-0158
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily