Basic Information
Provider Information
NPI: 1588631501
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILBERT
FirstName: JANET
MiddleName: BYRD
NamePrefix: MS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 44008
Address2: UFJP PROVIDER ENROLLMENT
City: JACKSONVILLE
State: FL
PostalCode: 322314008
CountryCode: US
TelephoneNumber: 9042443199
FaxNumber: 9042443425
Practice Location
Address1: 542190 US HIGHWAY 1
Address2: UFJP CALLAHAN FAMILY PRACTICE CENTER
City: CALLAHAN
State: FL
PostalCode: 320118109
CountryCode: US
TelephoneNumber: 9048799803
FaxNumber: 9048795833
Other Information
ProviderEnumerationDate: 03/08/2006
LastUpdateDate: 03/05/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XARNP730792FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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