Healthcare Provider Details

I. General information

NPI: 1386507150
Provider Name (Legal Business Name): PAOLA CRISTINA BRACHO GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17455 NW 94TH CT APT 107
HIALEAH FL
33018-4439
US

IV. Provider business mailing address

17455 NW 94TH CT APT 107
HIALEAH FL
33018-4439
US

V. Phone/Fax

Practice location:
  • Phone: 786-537-5405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11043856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: