Individual provider Active NPI

Joan Morrissey Gautreau, ARNP

  • Pediatric Nurse Practitioner
  • Palm City, FL
National Provider Identifier
1154420750
Registry record updated Jan 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
ARNP9190624 Issued in FL
Practice address
3573 SW Corporate Pkwy
Palm City, FL 34990-8153
Phone
(772) 283-5431
Fax
(772) 283-5471
NPI assigned
Sep 21, 2006
Last updated
Jan 4, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 4, 2013

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X ARNP9190624 FL Primary
Family Nurse Practitioner 363LF0000X ARNP 9190624 FL
Pediatric Nurse Practitioner 363LP0200X 7233 CA
Family Nurse Practitioner 363LF0000X 7233 CA

Addresses

Primary practice location

3573 SW Corporate Pkwy
Palm City, FL 34990-8153

Mailing address

9025 SW Sawgrass Way
Palm City, FL 34990-4105
Phone (772) 486-5174

Other identifiers 1

IdentifierTypeStateIssuer
306405100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ARNP 9190624FLMDFamily Nurse Practitioner
7233CAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
ENT and Allergy Associates of Florida, LLC Past Accepting new patients
DRS Berghash & Lanza PL Past Accepting new patients
All About Kids Pediatrics, Inc Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357257600000",
    "number": "1154420750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9025 SW SAWGRASS WAY",
            "city": "PALM CITY",
            "state": "FL",
            "postal_code": "349904105",
            "telephone_number": "772-486-5174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3573 SW CORPORATE PKWY",
            "city": "PALM CITY",
            "state": "FL",
            "postal_code": "349908153",
            "telephone_number": "772-283-5431",
            "fax_number": "772-283-5471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUTREAU",
        "first_name": "JOAN",
        "middle_name": "MORRISSEY",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2013-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP9190624",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP 9190624",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "7233",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "7233",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "306405100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.