MEDICARE: GINA HUTCHINS ESTALELLA

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	163WA2000X	Administrator Registered Nurse	9487332	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1477333110	OTHER	FL	NURSE REGISTRY

General Provider Information

NPI Number	:	1629858360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA HUTCHINS ESTALELLA

Provider Business Mailing Address
First Line	:	7605 DAVIE ROAD EXT
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2623
Country	:	US
Telephone Number	:	754-423-9476
Fax Number	:

Provider Business Practice Location Address
First Line	:	7605 DAVIE ROAD EXT
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2623
Country	:	US
Telephone Number	:	754-423-9476
Fax Number	:

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

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	12/04/2023

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