Healthcare Provider Details

I. General information

NPI: 1144991480
Provider Name (Legal Business Name): JENNIFER GAMBLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 OGLETOWN STANTON RD STE 217
NEWARK DE
19713-2074
US

IV. Provider business mailing address

4000 NEXUS DR
WILMINGTON DE
19803-3000
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-4387
  • Fax: 302-733-4252
Mailing address:
  • Phone: 302-623-2597
  • Fax: 302-623-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011583
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: