Provider Demographics
NPI:1861937021
Name:GILMORE, CHARMAINE GILLIAN (DNP,ARNP, FNP-C)
Entity type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:GILLIAN
Last Name:GILMORE
Suffix:
Gender:F
Credentials:DNP,ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 ALSHIRE CT N
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8457
Mailing Address - Country:US
Mailing Address - Phone:850-879-0684
Mailing Address - Fax:
Practice Address - Street 1:2617 MITCHAM DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5478
Practice Address - Country:US
Practice Address - Phone:850-878-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9218775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily