Gerisource

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

9260038 Issued in FL

Legal business name

GERISOURCE

Practice address

11812 Crusselle Dr
Jacksonville, FL 32223-0876

Phone

(904) 252-5265

NPI assigned

Nov 6, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Andrea H Clayman, ARNP

Title

President

Phone

(904) 252-5265

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1289001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289001600000",
    "number": "1871894972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11812 CRUSSELLE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322230876",
            "telephone_number": "904-252-5265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11812 CRUSSELLE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322230876",
            "telephone_number": "904-252-5265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERISOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-06",
        "last_updated": "2010-11-06",
        "status": "A",
        "authorized_official_last_name": "CLAYMAN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-252-5265",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "9260038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew James Geraci, PHARMD, EOD
• Gerard a Coluccelli MD PA
• Gerard a.Coluccelli,M.D. (See Clear Optical)
• Deborah A. Gerbert, PA-C
• Christopher Marc Geric, D.M.D.
• Kristen Gerking, PT, DPT
• Sharon Yvett Ezell Gerlach, M.D.
• Machel Suzon Germain, M.D.
• Wil Edvard Germain, M.D.
• Lavina Lashell German, ARNP

• Gerontology Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2010; 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.