Healthcare Provider Details

I. General information

NPI: 1073100509
Provider Name (Legal Business Name): JAMIE GABRIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 SOUTHWOOD PLANTATION RD
TALLAHASSEE FL
32311-4013
US

IV. Provider business mailing address

11 SASSAFRAS TRL
CRAWFORDVILLE FL
32327-2161
US

V. Phone/Fax

Practice location:
  • Phone: 850-815-8800
  • Fax:
Mailing address:
  • Phone: 816-728-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA97035
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: