Provider Demographics
NPI:1598918609
Name:GORDON, THELMA AGATHA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:THELMA
Middle Name:AGATHA
Last Name:GORDON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 SW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3697
Mailing Address - Country:US
Mailing Address - Phone:954-443-4902
Mailing Address - Fax:954-443-4902
Practice Address - Street 1:951 SW 98TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3697
Practice Address - Country:US
Practice Address - Phone:954-443-4902
Practice Address - Fax:954-443-4902
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1063282363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health