Provider Demographics
NPI:1073817151
Name:A NICHOLAS GUTIERREZ MD PA
Entity Type:Organization
Organization Name:A NICHOLAS GUTIERREZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-977-4426
Mailing Address - Street 1:13701 BRUCE B DOWNS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4647
Mailing Address - Country:US
Mailing Address - Phone:813-977-4426
Mailing Address - Fax:813-977-4428
Practice Address - Street 1:13701 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4647
Practice Address - Country:US
Practice Address - Phone:813-977-4426
Practice Address - Fax:813-977-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty