Provider Demographics
NPI:1922656354
Name:GILL, RAYMOND DAVID (APRN, CRNA)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DAVID
Last Name:GILL
Suffix:
Gender:M
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14057 SW 166TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2079
Mailing Address - Country:US
Mailing Address - Phone:305-926-6933
Mailing Address - Fax:
Practice Address - Street 1:14057 SW 166TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2079
Practice Address - Country:US
Practice Address - Phone:305-926-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9283621163WC0200X
FL11005964363L00000X
FLAPRN11005964367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner