Provider Demographics
NPI:1316340763
Name:ANIDJAR, GIMOL EDITH (ARNP)
Entity type:Individual
Prefix:
First Name:GIMOL
Middle Name:EDITH
Last Name:ANIDJAR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:
Other - Last Name:ANIDJAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:6000 ISLAND BLVD APT 3001
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3795
Mailing Address - Country:US
Mailing Address - Phone:786-247-6196
Mailing Address - Fax:
Practice Address - Street 1:2999 191ST ST
Practice Address - Street 2:SUITE 250
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-933-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9364624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily