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NPI Code Detail

MEDICARE: MRS. YESICA MARCELA GORDON RN

MEDICARE: MRS. YESICA MARCELA GORDON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse9645589FL

General Provider Information

NPI Number : 1427991892
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. YESICA MARCELA GORDON RN
Provider Business Mailing Address
First Line : 5576 FREESIA DR
Second Line :
City : LAKELAND
State : FL
Zip : 33811-2757
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1324 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4543
Country : US
Telephone Number : 863-687-1100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2026
Last Update Date : 04/10/2026

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