Provider Demographics
NPI:1073957205
Name:PICARD, GABRIELLE (AGNP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:PICARD
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9117 COLONY VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-5963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:228 WESTINGHOUSE BLVD
Practice Address - Street 2:104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6230
Practice Address - Country:US
Practice Address - Phone:866-460-3567
Practice Address - Fax:855-632-8329
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197383363LA2200X, 363LG0600X
NC5008799363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology