Provider Demographics
NPI:1770805699
Name:GONGORA-GARCIA, TERESA MARIA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIA
Last Name:GONGORA-GARCIA
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 1:983 SW 154TH PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2788
Mailing Address - Country:US
Mailing Address - Phone:786-537-0618
Mailing Address - Fax:
Practice Address - Street 1:11760 BIRD RD STE 741
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8104
Practice Address - Country:US
Practice Address - Phone:305-226-8484
Practice Address - Fax:305-226-8826
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9256923364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0000000000OtherIN PROGRESS