Healthcare Provider Details

I. General information

NPI: 1851959498
Provider Name (Legal Business Name): GABRIEL MICHAEL MERIWETHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD STREES
JACKSONVILLE FL
32214-4336
US

IV. Provider business mailing address

1561 ARIES CT
ORANGE PARK FL
32073-6001
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7300
  • Fax:
Mailing address:
  • Phone: 231-350-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number43156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: