Provider Demographics
NPI:1174709141
Name:GORDILLO, BRISEIDA (ARNP)
Entity type:Individual
Prefix:
First Name:BRISEIDA
Middle Name:
Last Name:GORDILLO
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 1:11430 N KENDALL DR STE 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1041
Mailing Address - Country:US
Mailing Address - Phone:305-905-4758
Mailing Address - Fax:305-677-3578
Practice Address - Street 1:11430 SW 88 STREET, SUITE 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-905-4758
Practice Address - Fax:305-677-3578
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9205771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily