Provider Demographics
NPI:1972067791
Name:LOZEAU, GABRIELLA GISELA (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:GISELA
Last Name:LOZEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-308-0280
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:5864 HIGHWAY 153 STE 112
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5187
Practice Address - Country:US
Practice Address - Phone:423-497-5359
Practice Address - Fax:423-877-5208
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111749363A00000X
TN4233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant