Provider Demographics
NPI:1689729733
Name:FLEURANVIL, GERALDA PHANOR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GERALDA
Middle Name:PHANOR
Last Name:FLEURANVIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16751 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2409
Mailing Address - Country:US
Mailing Address - Phone:786-564-9438
Mailing Address - Fax:305-705-4292
Practice Address - Street 1:16751 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:305-750-1158
Practice Address - Fax:305-705-4292
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104039363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9104039OtherPA LICENSE