Healthcare Provider Details

I. General information

NPI: 1215812037
Provider Name (Legal Business Name): GABRIELLE OTREMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3599 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4252
US

IV. Provider business mailing address

230 MOSSY PINE LN APT 7104
SAINT JOHNS FL
32259-4596
US

V. Phone/Fax

Practice location:
  • Phone: 904-345-7600
  • Fax:
Mailing address:
  • Phone: 320-292-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: