Provider Demographics
NPI:1598186355
Name:MADRIGAL, GLYSEL (FNP)
Entity Type:Individual
Prefix:
First Name:GLYSEL
Middle Name:
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904-590 BEVERLY ST.
Mailing Address - Street 2:
Mailing Address - City:THUNDER BAY
Mailing Address - State:ON
Mailing Address - Zip Code:P7B6H1
Mailing Address - Country:CA
Mailing Address - Phone:807-629-5177
Mailing Address - Fax:807-683-7404
Practice Address - Street 1:7832 COLLINS AVE APT 407
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2173
Practice Address - Country:US
Practice Address - Phone:305-484-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9228055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily