Provider Demographics
NPI:1760014310
Name:LUZON, GABRIELLE C (ARNP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:C
Last Name:LUZON
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 1:15429 81ST AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-8493
Mailing Address - Country:US
Mailing Address - Phone:253-232-7495
Mailing Address - Fax:
Practice Address - Street 1:1201 PACIFIC AVE STE C6
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4393
Practice Address - Country:US
Practice Address - Phone:253-232-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61037411363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner