Provider Demographics
NPI:1598113508
Name:GOBRE, GISELE NATACHA (NP-C)
Entity Type:Individual
Prefix:
First Name:GISELE
Middle Name:NATACHA
Last Name:GOBRE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 PARK HILL CIR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8411
Mailing Address - Country:US
Mailing Address - Phone:678-237-7423
Mailing Address - Fax:
Practice Address - Street 1:3535 PARK HILL CIR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8411
Practice Address - Country:US
Practice Address - Phone:678-237-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF0516486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily