Healthcare Provider Details

I. General information

NPI: 1194137679
Provider Name (Legal Business Name): JUDITH FAUSTIN-GABRIEL DR.PH, F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 11/08/2018
Certification Date: FAUSTIN-GABRIEL JUDITH 1800 PEMBROKE DR ORLANDO FL 32810 1800 PEMBROOK DR STE 300 ORLANDO FL 32810
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEMBROOK DR STE 300
ORLANDO FL
32810-6378
US

IV. Provider business mailing address

1800 PEMBROKE DR SUITE 300
ORLANDO FL
32810-5700
US

V. Phone/Fax

Practice location:
  • Phone: 407-667-3605
  • Fax:
Mailing address:
  • Phone: 925-365-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine
License Number9403240
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine
License Number9403240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: