Provider Demographics
NPI:1326571837
Name:GAMBONE, JUSTIN
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:GAMBONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 VINELAND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7860
Mailing Address - Country:US
Mailing Address - Phone:407-355-3120
Mailing Address - Fax:407-355-3119
Practice Address - Street 1:5979 VINELAND RD STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7860
Practice Address - Country:US
Practice Address - Phone:407-355-3120
Practice Address - Fax:407-355-3119
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant