Provider Demographics
NPI:1063805893
Name:GILLESPIE, DANIEL JAMES (AGPCNP-BC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34211 DENISE WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1808
Mailing Address - Country:US
Mailing Address - Phone:415-412-0287
Mailing Address - Fax:
Practice Address - Street 1:160 N LURING DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6801
Practice Address - Country:US
Practice Address - Phone:408-341-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686932-1163W00000X
NYF307616-1363LA2200X
CA95026743363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse