Provider Demographics
NPI:1073294583
Name:GUTIERREZ, JAMELA HENRIETTE
Entity Type:Individual
Prefix:MISS
First Name:JAMELA
Middle Name:HENRIETTE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19501 W COUNTRY CLUB DR APT 401
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2472
Mailing Address - Country:US
Mailing Address - Phone:954-817-9194
Mailing Address - Fax:
Practice Address - Street 1:16799 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3405
Practice Address - Country:US
Practice Address - Phone:305-652-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily