Provider Demographics
NPI:1578339065
Name:SHORT, GIA CHEZVON (RN)
Entity Type:Individual
Prefix:
First Name:GIA
Middle Name:CHEZVON
Last Name:SHORT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 SW 122ND AVE
Mailing Address - Street 2:APT 403
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:305-359-8406
Mailing Address - Fax:
Practice Address - Street 1:11322 MIRAMAR PKWY # 1112
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5805
Practice Address - Country:US
Practice Address - Phone:305-359-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9582976163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse