Provider Demographics
NPI:1225333982
Name:GONZALVO, GISELL LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:GISELL
Middle Name:LYNN
Last Name:GONZALVO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13103 SW 195TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4277
Mailing Address - Country:US
Mailing Address - Phone:305-282-9797
Mailing Address - Fax:
Practice Address - Street 1:242 NW LE JEUNE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5488
Practice Address - Country:US
Practice Address - Phone:305-778-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9180373363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care