Provider Demographics
NPI:1033737598
Name:FRATILA, GABRIELA ELENA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:ELENA
Last Name:FRATILA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:228 PONTE VEDRA PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-6611
Practice Address - Country:US
Practice Address - Phone:904-273-1180
Practice Address - Fax:904-273-6116
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTX90GOtherBCBS
FLNB251OtherMEDICARE