Provider Demographics
NPI:1831285832
Name:GAEBEL, GRETCHEN L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:L
Last Name:GAEBEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 SW WOODSIDE CT
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4337
Mailing Address - Country:US
Mailing Address - Phone:772-631-5873
Mailing Address - Fax:
Practice Address - Street 1:3511 SE WILLOUGHBY BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5059
Practice Address - Country:US
Practice Address - Phone:772-221-7789
Practice Address - Fax:772-221-8584
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101775363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
E7976ZMedicare PIN
P69750Medicare UPIN
E7976XMedicare PIN