Basic Information
| Provider Information | |||||||||
| NPI: | 1932107133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARGUILL | ||||||||
| FirstName: | NULMA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 S CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615481450 | ||||||||
| FaxNumber: | 5615481459 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 JFK DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615481450 | ||||||||
| FaxNumber: | 5615481459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 07/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TRN34039 | FL | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 007976400 | 05 | FL | MEDICAID | PA103267 | 01 | FL | MEDICAL LICENSE | OTHER |