Individual
BETHSAIDA LOPEZ GILLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
2626 CAPITAL MEDICAL BLVD, TALLAHASSEE, FL 32308-4402
(850) 325-5000
Mailing address
3554 LAKESHORE DR, TALLAHASSEE, FL 32312-1487
(850) 728-6503
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP 9281898
FL
363LA2100X
Acute Care Nurse Practitioner
APRN9281898
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0041333300
—
FL
Enumeration date
09/22/2011
Last updated
10/10/2022
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