Gillis, Keith Alan

Gillis, Keith Alan is an individual health care provider with primary practice located at 13340 Metro Pkwy Ste 400 , Fort Myers FL 33966-4818. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is his primary health care specialty. Gillis, Keith Alan can be contacted via phone (239) 343-1105.

Contact Information

Primary practice address
13340 Metro Pkwy Ste 400 Fort Myers FL 33966-4818
Phone: (239) 343-1105
Fax: (239) 343-1106
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X APRN9322325 Florida
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APRN9322325 Florida

Profile Details

NPI number 1376904334
LBN Legal business name Gillis, Keith Alan
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 17th, 2016
Last updated Apr 1st, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376904334 NPPES
Florida MEDICAID 016983200

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