Provider Demographics
NPI:1629671342
Name:GABLE, TIA MIRANDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:MIRANDA
Last Name:GABLE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:3257 CHATTANOOGA VALLEY RD
Practice Address - Street 2:
Practice Address - City:FLINTSTONE
Practice Address - State:GA
Practice Address - Zip Code:30725-2387
Practice Address - Country:US
Practice Address - Phone:706-841-7700
Practice Address - Fax:706-841-7800
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2023-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN199618363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA199618OtherGEORGIA LICENSE NUMBER