Healthcare Provider Details

I. General information

NPI: 1700546595
Provider Name (Legal Business Name): GASPAR M. CUADRAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14134 NEPHRON LN
HUDSON FL
34667-6504
US

IV. Provider business mailing address

415 NE 16TH PL
CAPE CORAL FL
33909-2259
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-5418
  • Fax:
Mailing address:
  • Phone: 239-699-8264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11016575
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11016575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: