Provider Demographics
NPI:1396762019
Name:GILLESPIE, MARJORIE MAY (PHD, PMHNP,M-CAP)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:MAY
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:PHD, PMHNP,M-CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16472
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33318-6472
Mailing Address - Country:US
Mailing Address - Phone:305-778-3157
Mailing Address - Fax:888-538-2226
Practice Address - Street 1:7800 W OAKLAND PARK BLVD STE 214
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-1126
Practice Address - Country:US
Practice Address - Phone:954-431-7676
Practice Address - Fax:888-538-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2809552363LP0808X, 363LF0000X
FLARNP2809552103TP0016X, 103TP2701X, 101YM0800X, 2084P0800X, 363L00000X, 363LA2200X
FLAPRN2809552363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8885YOtherMEDICARE
FL301733800Medicaid