Healthcare Provider Details

I. General information

NPI: 1053640607
Provider Name (Legal Business Name): TINA MARIE GEBAROWSKI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COUNTRYSIDE DR
MILFORD MA
01757-1252
US

IV. Provider business mailing address

1 COUNTRYSIDE DR
MILFORD MA
01757-1252
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-0435
  • Fax: 508-473-9755
Mailing address:
  • Phone: 508-473-0435
  • Fax: 508-473-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number236502
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: