Provider Demographics
NPI:1104692391
Name:GERGEL, MARIE CHRISTINE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:CHRISTINE
Last Name:GERGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32520 SPRING CORRAL CT
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-1652
Mailing Address - Country:US
Mailing Address - Phone:570-262-5954
Mailing Address - Fax:
Practice Address - Street 1:32520 SPRING CORRAL CT
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-1652
Practice Address - Country:US
Practice Address - Phone:570-262-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-307509163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant