Provider Demographics
NPI:1205504552
Name:GAMBOA, JOBELLE D (MSN-APRN)
Entity type:Individual
Prefix:
First Name:JOBELLE
Middle Name:D
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:MSN-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LEFEVRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1279
Mailing Address - Country:US
Mailing Address - Phone:815-625-0400
Mailing Address - Fax:815-626-2896
Practice Address - Street 1:100 E LEFEVRE RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1279
Practice Address - Country:US
Practice Address - Phone:815-625-0400
Practice Address - Fax:815-626-2896
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner