Healthcare Provider Details

I. General information

NPI: 1245036904
Provider Name (Legal Business Name): EVITA GISELE HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 SW 17TH LN
GAINESVILLE FL
32601-0021
US

IV. Provider business mailing address

1121 SW 17TH LN
GAINESVILLE FL
32601-0021
US

V. Phone/Fax

Practice location:
  • Phone: 239-826-6391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number465659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: