Healthcare Provider Details

I. General information

NPI: 1467253716
Provider Name (Legal Business Name): GYSSELL POLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 FOREST HILL BLVD STE 103
WEST PALM BEACH FL
33406-5854
US

IV. Provider business mailing address

7505 NW 5TH CT APT 206
MARGATE FL
33063-7463
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-4577
  • Fax: 561-964-4572
Mailing address:
  • Phone: 954-210-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11039260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: