Provider Demographics
NPI:1215547104
Name:GUTIERREZ, SUSANA (APRN)
Entity Type:Individual
Prefix:MS
First Name:SUSANA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20048 NW 64TH COURT RD
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2174
Mailing Address - Country:US
Mailing Address - Phone:786-663-9220
Mailing Address - Fax:
Practice Address - Street 1:20048 NW 64TH COURT RD
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2174
Practice Address - Country:US
Practice Address - Phone:786-663-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008364363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care