Provider Demographics
NPI:1760904247
Name:GUTIERREZ, SAUL GUILLERMO (ARNP)
Entity Type:Individual
Prefix:
First Name:SAUL
Middle Name:GUILLERMO
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 FENDER CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4787
Mailing Address - Country:US
Mailing Address - Phone:407-242-6430
Mailing Address - Fax:
Practice Address - Street 1:8552 PALM PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6432
Practice Address - Country:US
Practice Address - Phone:407-730-9911
Practice Address - Fax:407-778-1479
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9390647363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily