Provider Demographics
NPI:1447368352
Name:GALLOWAY, GERALDINE (APRN)
Entity type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:GERRI
Other - Middle Name:
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-3727
Mailing Address - Fax:239-343-2086
Practice Address - Street 1:2780 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5858
Practice Address - Country:US
Practice Address - Phone:239-343-3727
Practice Address - Fax:239-343-2086
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9165323363LA2100X
FLAPRN9165323363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115090700Medicaid
MD3700593OtherUNITED HLTHCARE NATIONAL
MD2618779OtherUNITED HLTHCARE
MD64873901OtherBLUE SHIELD
MD64873901OtherBLUE SHIELD