Healthcare Provider Details

I. General information

NPI: 1134058191
Provider Name (Legal Business Name): NINA GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CAPITAL MEDICAL BLVD
TALLAHASSEE FL
32308-4408
US

IV. Provider business mailing address

901 RIGGINS RD APT 735
TALLAHASSEE FL
32308-2204
US

V. Phone/Fax

Practice location:
  • Phone: 850-294-3249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number26080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: