Healthcare Provider Details

I. General information

NPI: 1114323235
Provider Name (Legal Business Name): RAISA ANTONIA GUTIERREZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

IV. Provider business mailing address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-8003
  • Fax: 305-689-8008
Mailing address:
  • Phone: 305-689-8003
  • Fax: 305-689-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9315882
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9315882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: