Provider Demographics
NPI:1376870394
Name:LANZETTA, GABRIELLE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANN
Last Name:LANZETTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 KEMPSVILLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3927
Mailing Address - Country:US
Mailing Address - Phone:757-252-5600
Mailing Address - Fax:757-226-0157
Practice Address - Street 1:844 KEMPSVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-252-5600
Practice Address - Fax:757-226-0157
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013679-1363A00000X
VA0110004929363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical