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General NPI Number Information
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NPI Number | 1104376722
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Entity Type | Individual
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Provider Name | NANCY JENNIFER GAVILANES FNP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2016
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 3736 W OAKLAND PARK BLVD
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-1157
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Country | US
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Telephone | 954-759-7599
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Fax | 954-888-3813
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Provider Business Mailing Address
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Address Line | 1700 NW 49TH ST STE 125
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-3750
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Country | US
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Telephone | 954-759-7599
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Fax | 954-888-3813
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F1016050
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License Number State | FL
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