Provider Demographics
NPI:1073684874
Name:GUTIERREZ, MARCELA G (ARNP)
Entity Type:Individual
Prefix:
First Name:MARCELA
Middle Name:G
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARCELA
Other - Middle Name:G
Other - Last Name:GRUBMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:615 E PRINCETON ST
Mailing Address - Street 2:SUITE 416
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1456
Mailing Address - Country:US
Mailing Address - Phone:407-303-1687
Mailing Address - Fax:407-303-1729
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 416
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-303-1687
Practice Address - Fax:407-303-1729
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3102182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3030521-00Medicaid
FLP07070Medicare UPIN
FL3030521-00Medicaid