Provider Demographics
NPI:1891329801
Name:PORTER, GABRIELLA (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:GARWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07027-1109
Mailing Address - Country:US
Mailing Address - Phone:347-631-7572
Mailing Address - Fax:
Practice Address - Street 1:304 CEDAR ST
Practice Address - Street 2:
Practice Address - City:GARWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07027-1109
Practice Address - Country:US
Practice Address - Phone:347-631-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345670-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily