Provider Demographics
NPI:1851792303
Name:FERNANDEZ, GABRIELLE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:ANN
Other - Last Name:DUNCHUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 23321
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-4321
Mailing Address - Country:US
Mailing Address - Phone:843-876-1344
Mailing Address - Fax:843-876-1347
Practice Address - Street 1:2200 CROW LN STE 301
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1663
Practice Address - Country:US
Practice Address - Phone:843-848-5340
Practice Address - Fax:843-848-5345
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057015363A00000X
SC4831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant