Basic Information
| Provider Information | |||||||||
| NPI: | 1588024285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GORDON | ||||||||
| FirstName: | KERRYROSE | ||||||||
| MiddleName: | JOYCEANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | A.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 SW 87TH AVENUE | ||||||||
| Address2: | SUITE C-340 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055950109 | ||||||||
| FaxNumber: | 3055957092 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 NORTH HIATUS ROAD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544310540 | ||||||||
| FaxNumber: | 9544310520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2016 | ||||||||
| LastUpdateDate: | 07/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | ARNP9287130 | FL | N | Nursing Service Providers | Registered Nurse | 363L00000X | 9287130 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.