Healthcare Provider Details

I. General information

NPI: 1275296378
Provider Name (Legal Business Name): GABRIELE MITTEREGGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2021
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 SE MAGNOLIA EXT
OCALA FL
34471-4443
US

IV. Provider business mailing address

12650 SE 120TH ST
DUNNELLON FL
34431-8300
US

V. Phone/Fax

Practice location:
  • Phone: 352-512-9703
  • Fax:
Mailing address:
  • Phone: 619-402-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11015988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: