Provider Demographics
NPI:1760149025
Name:RADEMAKER, GABRIELLE ELISE (CPNP)
Entity Type:Individual
Prefix:MISS
First Name:GABRIELLE
Middle Name:ELISE
Last Name:RADEMAKER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 HARDING PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2490
Mailing Address - Country:US
Mailing Address - Phone:615-297-9541
Mailing Address - Fax:
Practice Address - Street 1:4322 HARDING PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2490
Practice Address - Country:US
Practice Address - Phone:615-297-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30778363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics