Provider Demographics
NPI:1073100509
Name:GABRIEL, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 HANSEN CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4859
Mailing Address - Country:US
Mailing Address - Phone:850-320-6555
Mailing Address - Fax:888-873-4610
Practice Address - Street 1:2331 HANSEN CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4859
Practice Address - Country:US
Practice Address - Phone:850-320-6555
Practice Address - Fax:888-873-4610
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X, 106S00000X
FLMA97035225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist