Healthcare Provider Details

I. General information

NPI: 1619614674
Provider Name (Legal Business Name): GABRIELLE MEJIA-STANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 TAMIAMI TRL N
NAPLES FL
34108-2535
US

IV. Provider business mailing address

1397 ARECA CV
NAPLES FL
34119-3342
US

V. Phone/Fax

Practice location:
  • Phone: 239-597-8196
  • Fax:
Mailing address:
  • Phone: 239-571-9056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number101593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: