Healthcare Provider Details

I. General information

NPI: 1194198481
Provider Name (Legal Business Name): STEPHANIE GAUTHIER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18610 NW 87TH AVE
HIALEAH FL
33015-3518
US

IV. Provider business mailing address

8400 NW 33RD ST SUITE 100
DORAL FL
33122-1937
US

V. Phone/Fax

Practice location:
  • Phone: 305-921-7621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberARNP 9319093
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN9319093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: