Provider Demographics
NPI:1821518986
Name:AZIZ, GABRIELLE (RDN, LDN, CHES, CHC)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:
Last Name:AZIZ
Suffix:
Gender:F
Credentials:RDN, LDN, CHES, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 JOHN SIMS PKWY E STE 355
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1512 JOHN SIMS PKWY E STE 355
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2143
Practice Address - Country:US
Practice Address - Phone:601-670-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1056565133V00000X
FL174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator