Provider Demographics
NPI:1942696695
Name:DURAND-HERNANDEZ, GUSTAVO ENRIQUE (ARNP)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ENRIQUE
Last Name:DURAND-HERNANDEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:GUSTAVO
Other - Middle Name:ENRIQUE
Other - Last Name:DURAND-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3635 NE 1ST AVE
Mailing Address - Street 2:APT 1311
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3664
Mailing Address - Country:US
Mailing Address - Phone:787-587-8402
Mailing Address - Fax:
Practice Address - Street 1:3635 NE 1ST AVE
Practice Address - Street 2:APT 1311
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3664
Practice Address - Country:US
Practice Address - Phone:787-587-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9387321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily