Provider Demographics
NPI:1306494406
Name:GUTIERREZ, GISELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CORAL WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4924
Mailing Address - Country:US
Mailing Address - Phone:305-445-2941
Mailing Address - Fax:305-445-7231
Practice Address - Street 1:401 CORAL WAY, SUITE 207
Practice Address - Street 2:401 CORAL WAY SUITE 207
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-445-2941
Practice Address - Fax:305-445-7231
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003678207N00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207N00000XAllopathic & Osteopathic PhysiciansDermatology