Provider Demographics
NPI:1851959498
Name:MERIWETHER, GABRIEL MICHAEL
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MICHAEL
Last Name:MERIWETHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 ARIES CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-6001
Mailing Address - Country:US
Mailing Address - Phone:231-350-8485
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD STREES
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-4336
Practice Address - Country:US
Practice Address - Phone:904-542-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 390200000X
FL43156171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program