Healthcare Provider Details

I. General information

NPI: 1366723439
Provider Name (Legal Business Name): GABRIEL MIGUEL RODRIGUEZ SUAREZ AGNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6667 MILLER DR APT 603
MIAMI FL
33155-6446
US

IV. Provider business mailing address

6667 MILLER DR APT 603
MIAMI FL
33155-6446
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-5480
  • Fax:
Mailing address:
  • Phone: 786-312-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number10266
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG03210115
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11013151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: