| Doctor Name: | MS. PRISCILLA LEE GULLIVER |
| NPI Number: | 1356547251 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., |
| License Number: | MA18779 |
| Business Practice Address: | 2180 A1a S Suite 104 St Augustine, FL - 320806591 |
| Business Phone Number: | 9043477497 |
| Business Fax Number: | 9047977812 |
| Mailing Address: | 2180 A1a S, Suite 104 ST AUGUSTINE |
| State: | FL |
| Postal Code: | 320806591 |
| Phone Number: | 9043477497 |
| Fax Number: | 9047977812 |
| NPI Enumeration Date: | 06/26/2007 |
| NPI Last Update Date: | 04/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MA18779 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |