Provider Demographics
NPI:1922332550
Name:GABISCH, VIRGENE ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:VIRGENE
Middle Name:ANN
Last Name:GABISCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25924 COMANCHE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-4237
Mailing Address - Country:US
Mailing Address - Phone:352-799-7361
Mailing Address - Fax:
Practice Address - Street 1:25924 COMANCHE ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-4237
Practice Address - Country:US
Practice Address - Phone:352-799-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32910172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker