Provider Demographics
NPI:1063447993
Name:GRAY, ADELAIDA (ARNP)
Entity type:Individual
Prefix:
First Name:ADELAIDA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12751 WESTLINKS DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8615
Mailing Address - Country:US
Mailing Address - Phone:239-744-2300
Mailing Address - Fax:
Practice Address - Street 1:9470 HEALTHPARK CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3600
Practice Address - Country:US
Practice Address - Phone:239-985-1925
Practice Address - Fax:239-321-6044
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2951012363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01318679OtherRR MEDICARE
FLP114547OtherFREEDOM
FL308158300Medicaid
FL9279891OtherAETNA
FLP954066OtherOPTIMUM
FL398577OtherAVMED
FLY114UOtherBCBS OF FL
FL1249034OtherWELLCARE
FLU3031YMedicare PIN
FL1249034OtherWELLCARE
FLP954066OtherOPTIMUM