Provider Demographics
NPI:1275064222
Name:AMAYA, GABRIELA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:AMAYA
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 1:9475 LOTTSFORD RD STE 250
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5346
Mailing Address - Country:US
Mailing Address - Phone:301-636-6504
Mailing Address - Fax:
Practice Address - Street 1:5474 SAINT BARNABAS RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3622
Practice Address - Country:US
Practice Address - Phone:443-899-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1041937163W00000X
MDR223160163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR223160OtherRN LICENSE
DCRN1041937OtherRN LICENSE