Healthcare Provider Details

I. General information

NPI: 1669297511
Provider Name (Legal Business Name): GABRIELLE O'CONNELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2024
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 HULL RD
GAINESVILLE FL
32607-4144
US

IV. Provider business mailing address

PO BOX 112727
GAINESVILLE FL
32611-2727
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7002
  • Fax:
Mailing address:
  • Phone: 352-273-7001
  • Fax: 352-273-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: