Healthcare Provider Details

I. General information

NPI: 1982002788
Provider Name (Legal Business Name): RENETTE GABRIEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 PRATT BLVD
LABELLE FL
33935-4405
US

IV. Provider business mailing address

1140 PRATT BLVD
LABELLE FL
33935-4405
US

V. Phone/Fax

Practice location:
  • Phone: 863-674-4041
  • Fax: 863-612-0770
Mailing address:
  • Phone: 863-674-4041
  • Fax: 863-612-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9184453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: