Provider Demographics
NPI:1457828394
Name:PIERRE, GREGORY (APRN)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:PIERRE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12039 SW 132ND CT
Mailing Address - Street 2:UNIT 29
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4785
Mailing Address - Country:US
Mailing Address - Phone:786-217-7784
Mailing Address - Fax:
Practice Address - Street 1:12039 SW 132ND CT
Practice Address - Street 2:UNIT 29
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4785
Practice Address - Country:US
Practice Address - Phone:786-217-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9288616363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily