Provider Demographics
NPI:1063440410
Name:GUTIERREZ, ARMANDO NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:ARMANDO
Middle Name:NICHOLAS
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4647
Mailing Address - Country:US
Mailing Address - Phone:813-977-4426
Mailing Address - Fax:813-977-4428
Practice Address - Street 1:13701 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4647
Practice Address - Country:US
Practice Address - Phone:813-977-4426
Practice Address - Fax:813-977-4428
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0028029207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038970600Medicaid
225137OtherAVMED
705789OtherAETNA
FL30212OtherBLUE CROSS BLUE SHIELD
26927OtherWELLCARE
160033813OtherRAILROAD MEDICARE
FL30212OtherBLUE CROSS BLUE SHIELD
FL30212Medicare ID - Type Unspecified