Provider Demographics
NPI:1184050767
Name:GABRIEL, ALEXANDRA KELLY (ARNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KELLY
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WILLOW OAK WAY
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-2509
Mailing Address - Country:US
Mailing Address - Phone:386-586-4280
Mailing Address - Fax:386-586-4286
Practice Address - Street 1:120 CYPRESS EDGE DRIVE
Practice Address - Street 2:#102
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2509
Practice Address - Country:US
Practice Address - Phone:386-586-4280
Practice Address - Fax:386-586-4286
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60405652363LF0000X
FLARNP9427929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily