Provider Demographics
NPI:1568933984
Name:FERNANDEZ, GILDA ROSA
Entity Type:Individual
Prefix:MRS
First Name:GILDA
Middle Name:ROSA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6581 CASA LINDA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1015
Mailing Address - Country:US
Mailing Address - Phone:786-307-5809
Mailing Address - Fax:
Practice Address - Street 1:6166 S SANDHILL RD STE 112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3216
Practice Address - Country:US
Practice Address - Phone:725-248-9127
Practice Address - Fax:702-495-4475
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000494363LG0600X
NV818080363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology