Mallory M Gustafson, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP9383627 Issued in FL

Practice address

632 E Victoria Trails Blvd
Deland, FL 32724-7911

Phone

(970) 443-0948

NPI assigned

Jan 31, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IDBBDD/Endpoint/IDBBDD
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Emergency Physicians of Central Florida LLP

  • Emergency Medicine Physician
  • Orlando, FL
  • NPI 1326033341
  Medicare reassignment NPD
• Excellence Health, LLC

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1447741749
  Medicare reassignment NPD
• Lewis & Klancke Cardiology PA

  • Cardiovascular Disease Physician
  • Daytona Beach, FL
  • NPI 1669589263
  Medicare reassignment NPD
• Cardiology Physicians Memorial, LLC

  • Cardiovascular Disease Physician
  • Daytona Beach, FL
  • NPI 1740559855
  Medicare reassignment

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

{
    "created_epoch": "1517356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517356800000",
    "number": "1144728486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 E VICTORIA TRAILS BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327247911",
            "telephone_number": "970-443-0948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 E VICTORIA TRAILS BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327247911",
            "telephone_number": "970-443-0948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "MALLORY",
        "middle_name": "M",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-31",
        "last_updated": "2018-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9383627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anika Gupta
• Anjali Gupta, MD
• Shreya Gupta
• Suman Gupta, M.D.
• April Gustafson, APRN
• Misty Gutierrez, RN
• GV Deland, LLC
• Bridget C Hackett, LMHC
• Adam Christopher Hagely, PT, DPT
• Edrian J Hairston, MS ATC LAT

• Family Nurse Practitioner in Deland, FL
• Providers in Deland, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.