Provider Demographics
NPI:1467253716
Name:POLO, GYSSELL (FNP)
Entity type:Individual
Prefix:
First Name:GYSSELL
Middle Name:
Last Name:POLO
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 NW 5TH CT APT 206
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7463
Mailing Address - Country:US
Mailing Address - Phone:954-210-3648
Mailing Address - Fax:
Practice Address - Street 1:7505 NW 5TH CT APT 206
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7463
Practice Address - Country:US
Practice Address - Phone:954-210-3648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF02250845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily