MEDICARE: NANCY JENNIFER GAVILANES FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F1016050	FL

General Provider Information

NPI Number	:	1104376722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY JENNIFER GAVILANES FNP

Provider Business Mailing Address
First Line	:	1700 NW 49TH ST STE 125
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3750
Country	:	US
Telephone Number	:	954-759-7599
Fax Number	:	954-888-3813

Provider Business Practice Location Address
First Line	:	3736 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33311-1157
Country	:	US
Telephone Number	:	954-759-7599
Fax Number	:	954-888-3813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	06/27/2024

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