Provider Demographics
NPI:1396324620
Name:FONTANEZ, GLADYS YAMILCA (ARNP)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:YAMILCA
Last Name:FONTANEZ
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 1:4798 SW 134TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-7868
Mailing Address - Country:US
Mailing Address - Phone:352-433-6952
Mailing Address - Fax:
Practice Address - Street 1:4798 SW 134TH LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-7868
Practice Address - Country:US
Practice Address - Phone:352-433-6952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012335363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty