Healthcare Provider Details

I. General information

NPI: 1073957205
Provider Name (Legal Business Name): GABRIELLE PICARD AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 SUNRISE BEACH RD
CROWNSVILLE MD
21032-1126
US

IV. Provider business mailing address

1002 MALLONEE LN
CROWNSVILLE MD
21032-1850
US

V. Phone/Fax

Practice location:
  • Phone: 410-507-3331
  • Fax: 410-275-0491
Mailing address:
  • Phone: 410-507-3331
  • Fax: 410-275-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR197383
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR197383
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5008799
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: