Provider Demographics
NPI:1487170460
Name:MAI, GABRIELLE (APRN)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:MAI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4033 TAMPA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3224
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-436-5378
Practice Address - Street 1:1854 OAK GROVE BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-8605
Practice Address - Country:US
Practice Address - Phone:813-948-6133
Practice Address - Fax:813-948-1258
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.016283363LP0200X
FLAPRN11001110363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics