Provider Demographics
NPI:1205327749
Name:GAMIOTEA, PRISCILA MARIE
Entity type:Individual
Prefix:
First Name:PRISCILA
Middle Name:MARIE
Last Name:GAMIOTEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 NW 70TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7578
Mailing Address - Country:US
Mailing Address - Phone:954-223-5483
Mailing Address - Fax:954-223-5484
Practice Address - Street 1:499 NW 70TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-7578
Practice Address - Country:US
Practice Address - Phone:954-223-5483
Practice Address - Fax:954-223-5484
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9111255363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical