Individual provider Active NPI

Deborah Lynn Gilmore, ARNP

  • Adult Health Nurse Practitioner
  • Fort Walton Beach, FL
National Provider Identifier
1104248251
Registry record updated Jan 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
ARNP9213456 Issued in FL
Practice address
1005 Mar Walt Drive
Pulmonology Department
Fort Walton Beach, FL 32547-6796
Phone
(850) 243-0118
Fax
(850) 243-0594
NPI assigned
Jan 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X ARNP9213456 FL Primary

Addresses

Primary practice location

1005 Mar Walt Drive
Pulmonology Department
Fort Walton Beach, FL 32547-6796

Mailing address

1005 Mar Walt Drive
Pulmonology Department
Fort Walton Beach, FL 32547-6796
Phone (850) 243-0118

Other identifiers 2

IdentifierTypeStateIssuer
010771700MedicaidFL
Y0L8FOtherFLBCBSFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140214001107 FL Practitioner - Nurse Practitioner 5890924831 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

Practice roles

OrganizationSpecialtyStatusNew patients
North Florida Surgeons, PA CurrentSince Feb 5, 2024 Accepting new patients
North Florida Surgeons, PA CurrentSince Feb 5, 2024 Accepting new patients
White-Wilson Medical Center PA CurrentSince Nov 14, 2014 Accepting new patients

Locations

1340 S 18th St
Ste 104
Fernandina Beach, FL 32034
Phone (904) 277-3277

310 Racetrack Rd NW
Fort Walton Beach, FL 32547
Phone (850) 362-7330

1005 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 863-8100

11945 San Jose Blvd
Ste 300
Jacksonville, FL 32223

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484611200000",
    "number": "1104248251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DRIVE",
            "address_2": "PULMONOLOGY DEPARTMENT",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476796",
            "telephone_number": "850-243-0118",
            "fax_number": "850-243-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DRIVE",
            "address_2": "PULMONOLOGY DEPARTMENT",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476796",
            "telephone_number": "850-243-0118",
            "fax_number": "850-243-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILMORE",
        "first_name": "DEBORAH",
        "middle_name": "LYNN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-08",
        "last_updated": "2017-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP9213456",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010771700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "Y0L8F",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.