Provider Demographics
NPI:1649753724
Name:GUTIERREZ, KATIUSKA
Entity Type:Individual
Prefix:
First Name:KATIUSKA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUNSHINE SENIORS
Other - Middle Name:
Other - Last Name:HELPERS.LLC (D.B.A)
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DBA
Mailing Address - Street 1:9509 BAYTREE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1976
Mailing Address - Country:US
Mailing Address - Phone:813-507-3647
Mailing Address - Fax:813-243-1388
Practice Address - Street 1:9509 BAYTREE CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1976
Practice Address - Country:US
Practice Address - Phone:813-577-0547
Practice Address - Fax:813-243-1388
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 385H00000X, 376J00000X
FL235577372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104110300Medicaid