Provider Demographics
NPI:1841389327
Name:GERSON, EFERILDIA STELLA (ARNP)
Entity Type:Individual
Prefix:
First Name:EFERILDIA
Middle Name:STELLA
Last Name:GERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:EFERILDIA
Other - Middle Name:STELLA
Other - Last Name:BAEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:11440 SW 88TH ST
Mailing Address - Street 2:STE. 109
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1044
Mailing Address - Country:US
Mailing Address - Phone:786-263-0001
Mailing Address - Fax:786-263-0004
Practice Address - Street 1:11440 SW 88TH ST
Practice Address - Street 2:STE. 109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1044
Practice Address - Country:US
Practice Address - Phone:786-263-0001
Practice Address - Fax:786-263-0004
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2047952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0345865 00Medicaid
FL0345865 00Medicaid
570838Medicare UPIN