Basic Information
| Provider Information | |||||||||
| NPI: | 1093061723 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTANEZ GALVIS | ||||||||
| FirstName: | GERARDO | ||||||||
| MiddleName: | AUGUSTO | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6520 FORT CAROLINE RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322772044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047453618 | ||||||||
| FaxNumber: | 9047224271 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 DUNN AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322186330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046967474 | ||||||||
| FaxNumber: | 9046967476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2012 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9285572 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.