Provider Demographics
NPI:1487620621
Name:HALL, GERALD W JR (DNP, APRN, CPNP)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:W
Last Name:HALL
Suffix:JR
Gender:M
Credentials:DNP, APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 5TH ST S STE 510
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:478-508-5802
Mailing Address - Fax:850-883-8133
Practice Address - Street 1:601 5TH ST S STE 510
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-3117
Practice Address - Fax:727-767-2590
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488071363LP0200X
FL9450322363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics