=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104221597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH GAMEZ PARDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2014
-----------------------------------------------------
Last Update Date | 05/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1176 SW 67TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-359-9838
-----------------------------------------------------
Fax | 786-224-6490
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7925 NW 12TH ST STE 201
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-874-3909
-----------------------------------------------------
Fax | 305-874-3916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9358279
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------