Healthcare Provider Details

I. General information

NPI: 1164069720
Provider Name (Legal Business Name): AMY HILARY GORDON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY HILARY KESTER CNM

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SE 3RD AVE # 502
FORT LAUDERDALE FL
33316-2521
US

IV. Provider business mailing address

14731 MADISON PL
DAVIE FL
33325-3039
US

V. Phone/Fax

Practice location:
  • Phone: 954-581-8706
  • Fax:
Mailing address:
  • Phone: 508-292-8095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11005201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: