Provider Demographics
NPI:1750825543
Name:ESTRADA, GRETHELL (ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:GRETHELL
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:GRETHELL
Other - Middle Name:
Other - Last Name:ESTRADA FOLGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7900 NW 27TH AVE UNIT D-10
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4909
Mailing Address - Country:US
Mailing Address - Phone:305-403-4003
Mailing Address - Fax:305-403-4006
Practice Address - Street 1:7900 NW 27TH AVE UNIT D-10
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4909
Practice Address - Country:US
Practice Address - Phone:305-403-4003
Practice Address - Fax:305-403-4006
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9328788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019690300Medicaid