Provider Demographics
NPI:1548874795
Name:GABRIEL, OCTAVIA LYNNETTE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:LYNNETTE
Last Name:GABRIEL
Suffix:
Gender:F
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 1:23841 DEVOE AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2219
Mailing Address - Country:US
Mailing Address - Phone:216-402-3960
Mailing Address - Fax:
Practice Address - Street 1:13944 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3804
Practice Address - Country:US
Practice Address - Phone:216-767-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027117363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner