Provider Demographics
NPI:1073381653
Name:DUVERGEL, GRISELDA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:DUVERGEL
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 NW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7207
Mailing Address - Country:US
Mailing Address - Phone:786-516-0636
Mailing Address - Fax:
Practice Address - Street 1:11201 NW 45TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-7207
Practice Address - Country:US
Practice Address - Phone:786-516-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9531835163W00000X
FL11030045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse