Provider Demographics
NPI:1821579897
Name:PADILLA GUTIERREZ, PAULETTE C (ARNP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:C
Last Name:PADILLA GUTIERREZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13545 SW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4515
Mailing Address - Country:US
Mailing Address - Phone:305-562-4016
Mailing Address - Fax:
Practice Address - Street 1:18219 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1417
Practice Address - Country:US
Practice Address - Phone:786-465-6689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9329353363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner