Provider Demographics
NPI:1518757632
Name:GORDON, KIMESHA SHERRIKA (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMESHA
Middle Name:SHERRIKA
Last Name:GORDON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5363
Mailing Address - Country:US
Mailing Address - Phone:954-997-0471
Mailing Address - Fax:
Practice Address - Street 1:4303 HAYES ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5363
Practice Address - Country:US
Practice Address - Phone:954-997-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily