Healthcare Provider Details

I. General information

NPI: 1417351735
Provider Name (Legal Business Name): ANN MARIE GAMBLE CRNP-FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BOW ST
ELKTON MD
21921-5544
US

IV. Provider business mailing address

3401 CAYMAN WAY APT 412
ABINGDON MD
21009-2886
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-4000
  • Fax:
Mailing address:
  • Phone: 302-584-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR224551
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG0011657
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAN-0024823
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR224551
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0011657
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC001406
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberL1-0035904
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: