Healthcare Provider Details

I. General information

NPI: 1609642701
Provider Name (Legal Business Name): GABRIELLA JUDITH HAIMES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 LITTLE RD
TRINITY FL
34655-4421
US

IV. Provider business mailing address

9800 TRUMPET VINE LOOP
TRINITY FL
34655-5375
US

V. Phone/Fax

Practice location:
  • Phone: 727-859-2014
  • Fax:
Mailing address:
  • Phone: 727-859-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10231102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: