Provider Demographics
NPI:1093564759
Name:GABBARD, LORAINE T (APRN - AGPCNP)
Entity type:Individual
Prefix:MRS
First Name:LORAINE
Middle Name:T
Last Name:GABBARD
Suffix:
Gender:F
Credentials:APRN - AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5104 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2702
Mailing Address - Country:US
Mailing Address - Phone:941-565-3949
Mailing Address - Fax:941-746-2780
Practice Address - Street 1:5104 1ST AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2702
Practice Address - Country:US
Practice Address - Phone:941-565-3949
Practice Address - Fax:941-746-2780
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAG03240064363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty