Provider Demographics
NPI:1265197289
Name:COIMBRA, GABRIEL (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:COIMBRA
Suffix:
Gender:M
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6557 SILVERADO RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-2546
Mailing Address - Country:US
Mailing Address - Phone:508-360-1469
Mailing Address - Fax:
Practice Address - Street 1:6557 SILVERADO RANCH BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-2546
Practice Address - Country:US
Practice Address - Phone:508-360-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11016426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9I6TIOtherBLUE CROSS BLUE SHIELD
FL112847300Medicaid