Provider Demographics
NPI:1053757740
Name:GUTIERREZ, NINOSKA M (PA)
Entity type:Individual
Prefix:
First Name:NINOSKA
Middle Name:M
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2500 STARLING ST STE 506
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4270
Mailing Address - Country:US
Mailing Address - Phone:912-265-5125
Mailing Address - Fax:
Practice Address - Street 1:2500 STARLING ST STE 506
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4270
Practice Address - Country:US
Practice Address - Phone:912-265-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant