Individual
KARISSA CARRIE GILMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
518 SW PRIMA VISTA BLVD, PORT SAINT LUCIE, FL 34983-8734
(772) 873-8811
Mailing address
2407 SE MARIUS ST, PORT SAINT LUCIE, FL 34952-7276
(772) 812-6056
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
G240-129-67-600-0
FL
Other
Enumeration date
06/13/2025
Last updated
06/13/2025
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