Provider Demographics
NPI:1154420750
Name:GAUTREAU, JOAN MORRISSEY (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MORRISSEY
Last Name:GAUTREAU
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 1:9025 SW SAWGRASS WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4105
Mailing Address - Country:US
Mailing Address - Phone:772-486-5174
Mailing Address - Fax:
Practice Address - Street 1:3573 SW CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8153
Practice Address - Country:US
Practice Address - Phone:772-283-5431
Practice Address - Fax:772-283-5471
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9190624363LP0200X
FLARNP 9190624363LF0000X
CA7233363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306405100Medicaid
FLEE662ZMedicare UPIN