Provider Demographics
NPI:1659984649
Name:HASAN, GABRIELLE AJA (FNP)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:AJA
Last Name:HASAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:GABRIELLE
Other - Middle Name:AJA
Other - Last Name:ARTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3614 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3352
Mailing Address - Country:US
Mailing Address - Phone:817-870-1873
Mailing Address - Fax:
Practice Address - Street 1:3614 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3352
Practice Address - Country:US
Practice Address - Phone:817-870-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily