Healthcare Provider Details

I. General information

NPI: 1144866641
Provider Name (Legal Business Name): GABRIELLE NEMBHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 N UNIVERSITY DR
HOLLYWOOD FL
33024-2200
US

IV. Provider business mailing address

7012 NW 108TH AVE
TAMARAC FL
33321-1034
US

V. Phone/Fax

Practice location:
  • Phone: 954-442-9422
  • Fax:
Mailing address:
  • Phone: 516-426-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: