Provider Demographics
NPI:1275064222
Name:AMAYA, GABRIELA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:AMAYA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11683 HENLEY CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-4100
Mailing Address - Country:US
Mailing Address - Phone:240-416-3733
Mailing Address - Fax:949-695-2597
Practice Address - Street 1:3261 OLD WASHINGTON RD STE 3021
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3229
Practice Address - Country:US
Practice Address - Phone:240-416-3733
Practice Address - Fax:949-695-2597
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR223160163W00000X, 363LF0000X, 363LP0808X
DCRN1041937163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR223160OtherRN LICENSE
DCRN1041937OtherRN LICENSE