Provider Demographics
NPI:1457812026
Name:JIMENEZ, GABRIELLE D (APN)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:D
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:D
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:4510 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2210
Mailing Address - Country:US
Mailing Address - Phone:856-439-0060
Mailing Address - Fax:856-452-0344
Practice Address - Street 1:4510 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2210
Practice Address - Country:US
Practice Address - Phone:856-439-0060
Practice Address - Fax:856-452-0344
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00907900363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ14449580OtherCAQH