Healthcare Provider Details

I. General information

NPI: 1982337390
Provider Name (Legal Business Name): REGLA C GUTIERREZ MORALES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2022
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9088 PROGRESS BLVD
RIVERVIEW FL
33578-4886
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-0220
  • Fax: 813-367-1961
Mailing address:
  • Phone: 786-322-7333
  • Fax: 786-347-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11020563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: