Provider Demographics
NPI:1033406616
Name:GABBARD, JACQUELINE L (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:L
Last Name:GABBARD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:IN
Mailing Address - Zip Code:47335-0516
Mailing Address - Country:US
Mailing Address - Phone:765-238-0230
Mailing Address - Fax:
Practice Address - Street 1:2755 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-9341
Practice Address - Country:US
Practice Address - Phone:812-222-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003634B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily