Healthcare Provider Details

I. General information

NPI: 1992568687
Provider Name (Legal Business Name): GABRIELA SILVEIRA PIMENTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CUMBERLAND PARK DR STE 100
ST AUGUSTINE FL
32095-8955
US

IV. Provider business mailing address

11480 RED KOI DR
JACKSONVILLE FL
32226-2173
US

V. Phone/Fax

Practice location:
  • Phone: 904-201-9129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-325314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: