Provider Demographics
NPI:1275296378
Name:MITTEREGGER, GABRIELE
Entity Type:Individual
Prefix:
First Name:GABRIELE
Middle Name:
Last Name:MITTEREGGER
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 1:12650 SE 120TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-8300
Mailing Address - Country:US
Mailing Address - Phone:619-402-4332
Mailing Address - Fax:
Practice Address - Street 1:1490 SE MAGNOLIA EXT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4443
Practice Address - Country:US
Practice Address - Phone:352-512-9703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner