Provider Demographics
NPI:1598753287
Name:GMEREK-PETTUS, SABRINA P (ARNP)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:P
Last Name:GMEREK-PETTUS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-447-7120
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:7649 W COLONIAL DR STE 115
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7423
Practice Address - Country:US
Practice Address - Phone:407-522-2080
Practice Address - Fax:833-963-0115
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2830312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL309146500Medicaid
FL308670401Medicaid