Provider Demographics
NPI:1477249076
Name:JONES, GABRIELLA TATIANA
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:TATIANA
Last Name:JONES
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 1:11260 E SANDY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73432-8631
Mailing Address - Country:US
Mailing Address - Phone:580-371-1980
Mailing Address - Fax:
Practice Address - Street 1:11260 E SANDY CREEK RD
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:OK
Practice Address - Zip Code:73432-8631
Practice Address - Country:US
Practice Address - Phone:580-371-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program