Individual
CATHLEEN NMN GILLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5309 19TH AVE W, BRADENTON, FL 34209-5069
(302) 249-2270
Mailing address
5309 19TH AVE W, BRADENTON, FL 34209-5069
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
9511692
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2862350
FL LICENSE QUALITY ASSURANCE
FL
01
—
9511692
FL DEPT OF MEDICAL QUALITY ASSURANCE
FL
Enumeration date
01/19/2021
Last updated
01/19/2021
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