Provider Demographics
NPI:1104376722
Name:GAVILANES, NANCY JENNIFER (FNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JENNIFER
Last Name:GAVILANES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-759-7599
Mailing Address - Fax:954-888-3813
Practice Address - Street 1:3736 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-1157
Practice Address - Country:US
Practice Address - Phone:954-759-7599
Practice Address - Fax:954-888-3813
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF1016050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily