Provider Demographics
NPI:1205187234
Name:QUAN VIE, GISELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GISELLE
Middle Name:
Last Name:QUAN VIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GISELLE
Other - Middle Name:
Other - Last Name:LIE-TEN-SOENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:1190 NW 95TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2064
Practice Address - Country:US
Practice Address - Phone:305-691-2550
Practice Address - Fax:305-696-4610
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106643363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9106643OtherFLORIDA LICENSE NUMBER