MEDICARE: MR. HECTOR F GORDILLO APRN

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	363LC0200X	Critical Care Medicine Nurse Practitioner	ARNP9194190	FL
2	363LA2200X	Adult Health Nurse Practitioner	APRN9194190	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144611716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HECTOR F GORDILLO APRN

Provider Business Mailing Address
First Line	:	11337 SW 112TH CIRCLE LN N
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-8433
Country	:	US
Telephone Number	:	786-877-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 NW 12TH AVE STE C402
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1005
Country	:	US
Telephone Number	:	305-585-1111
Fax Number	:

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

Provider Enumeration Date	:	02/18/2015
Last Update Date	:	06/14/2024

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