Provider Demographics
NPI:1306267166
Name:ROBERT L GAUNT, FNP-BC LLC
Entity type:Organization
Organization Name:ROBERT L GAUNT, FNP-BC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:GAUNT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:480-398-7795
Mailing Address - Street 1:111 W 6TH ST
Mailing Address - Street 2:UNIT 607
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3991
Mailing Address - Country:US
Mailing Address - Phone:480-398-7795
Mailing Address - Fax:480-269-8505
Practice Address - Street 1:111 W 6TH ST
Practice Address - Street 2:UNIT 607
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-3991
Practice Address - Country:US
Practice Address - Phone:480-398-7795
Practice Address - Fax:480-269-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty