Provider Demographics
NPI:1376195826
Name:TAMAYO, GISELLE CARIDAD (APRN, NP-C, RN)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:CARIDAD
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:APRN, NP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11460 SW 204TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1047
Mailing Address - Country:US
Mailing Address - Phone:305-962-2770
Mailing Address - Fax:
Practice Address - Street 1:11460 SW 204TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-1047
Practice Address - Country:US
Practice Address - Phone:305-962-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner