Healthcare Provider Details

I. General information

NPI: 1649183419
Provider Name (Legal Business Name): NORMAN RENATO M GACIAS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25712 W 12 MILE RD
SOUTHFIELD MI
48034-1881
US

IV. Provider business mailing address

25712 W 12 MILE RD APT 102
SOUTHFIELD MI
48034-1882
US

V. Phone/Fax

Practice location:
  • Phone: 248-896-4212
  • Fax:
Mailing address:
  • Phone: 248-896-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704398042
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: