Healthcare Provider Details

I. General information

NPI: 1922656354
Provider Name (Legal Business Name): RAYMOND DAVID GILL APRN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 04/11/2022
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14057 SW 166TH ST
MIAMI FL
33177-2079
US

IV. Provider business mailing address

14057 SW 166TH ST
MIAMI FL
33177-2079
US

V. Phone/Fax

Practice location:
  • Phone: 305-926-6933
  • Fax:
Mailing address:
  • Phone: 305-926-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9283621
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11005964
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11005964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: