Jacqueline Desiree Gagnon

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN11003988 Issued in FL

Practice address

640 Randall Roberts Rd
Fort Walton Beach, FL 32547-1921

Phone

(803) 565-4270

NPI assigned

Sep 10, 2019

Last updated

Sep 10, 2019By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• The Southern Practitioner Group

  • Family Nurse Practitioner
  • Pensacola, FL
  • NPI 1063389377
  NPD (past)

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1952950040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 RANDALL ROBERTS RD",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471921",
            "telephone_number": "803-565-4270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 RANDALL ROBERTS RD",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471921",
            "telephone_number": "803-565-4270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "JACQUELINE",
        "middle_name": "DESIREE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-10",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "APRN11003988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Furr
• Thomas Arthur Fusco, D.P.M.
• Krista Maria Fylak, MA, OTR/L
• Mackenzie Anne Gabreski, LPC, LCPC, LIMHP
• Larry Charles Gabriel, M.D.
• Maria Elen P. Gajo, MD
• Omer Gal, M.D.
• Kathleen S Gallardo, LMT
• Mary Ganz, PT, DPT
• Noelia Maria Garcia, FNP-C

• Gerontology Nurse Practitioner in Fort Walton Beach, FL
• Providers in Fort Walton Beach, 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 Sep 10, 2019; 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.