Healthcare Provider Details

I. General information

NPI: 1255261004
Provider Name (Legal Business Name): MS. GABRIELLE PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 E CALL ST STE 100
STARKE FL
32091-3616
US

IV. Provider business mailing address

9452 WARHAWK RD
JACKSONVILLE FL
32221-8031
US

V. Phone/Fax

Practice location:
  • Phone: 904-364-2900
  • Fax:
Mailing address:
  • Phone: 904-599-1487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: