Healthcare Provider Details

I. General information

NPI: 1255809737
Provider Name (Legal Business Name): GISSELLE MARIA QUINTANA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT STE 302
MIAMI FL
33155-4071
US

IV. Provider business mailing address

9960 NW 116TH WAY STE 13
MEDLEY FL
33178-1175
US

V. Phone/Fax

Practice location:
  • Phone: 954-371-0107
  • Fax: 305-663-2813
Mailing address:
  • Phone: 786-924-1311
  • Fax: 786-924-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11000033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: