Healthcare Provider Details

I. General information

NPI: 1013687771
Provider Name (Legal Business Name): GISSY L SUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 N HIGHLAND AVE
TAMPA FL
33603-4724
US

IV. Provider business mailing address

701 94TH AVE N STE 250
SAINT PETERSBURG FL
33702-2448
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-3854
  • Fax: 727-327-7670
Mailing address:
  • Phone: 727-321-3854
  • Fax: 727-327-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11015376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: