Healthcare Provider Details

I. General information

NPI: 1467260620
Provider Name (Legal Business Name): MIGUEL ALEJANDRO GUTIERREZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 45TH ST STE 210
WEST PALM BEACH FL
33407-2015
US

IV. Provider business mailing address

308 NW 5TH AVE
OKEECHOBEE FL
34972-2568
US

V. Phone/Fax

Practice location:
  • Phone: 863-261-8354
  • Fax:
Mailing address:
  • Phone: 863-261-8354
  • Fax: 863-638-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11036851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: