Healthcare Provider Details

I. General information

NPI: 1407195787
Provider Name (Legal Business Name): CYNTHIA SCARLETT GORDON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA SCARLETT HERNANDEZ APRN

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

19101 MYSTIC POINTE DR APT 1404
AVENTURA FL
33180-4517
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-4462
  • Fax:
Mailing address:
  • Phone: 305-951-3698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberARNP9280139
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9280139
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9280139
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN9280139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: