Provider Demographics
NPI:1497383129
Name:GBELAYAN, ALICE (RN)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:GBELAYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5858 THEED ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-4649
Mailing Address - Country:US
Mailing Address - Phone:904-554-0931
Mailing Address - Fax:
Practice Address - Street 1:5858 THEED ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-4649
Practice Address - Country:US
Practice Address - Phone:904-554-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9510623163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse