Provider Demographics
NPI:1386330397
Name:LAVERDE, GLORIA ESPERANZA (FNP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ESPERANZA
Last Name:LAVERDE
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 1:3370 NE 190TH ST APT 1105
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2408
Mailing Address - Country:US
Mailing Address - Phone:786-859-6076
Mailing Address - Fax:
Practice Address - Street 1:800 SE 4TH AVE STE 502
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6494
Practice Address - Country:US
Practice Address - Phone:305-931-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty