Provider Demographics
NPI:1689458580
Name:GUTIERREZ, YARISBEL (APRN)
Entity Type:Individual
Prefix:
First Name:YARISBEL
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 WINDTREE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1219
Mailing Address - Country:US
Mailing Address - Phone:813-446-1972
Mailing Address - Fax:
Practice Address - Street 1:1818 SHORT BRANCH DR STE 102
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-4425
Practice Address - Country:US
Practice Address - Phone:727-372-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028077207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty