Healthcare Provider Details

I. General information

NPI: 1376460980
Provider Name (Legal Business Name): GABRYLLE PENAFLORIDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N INGALLS ST
ANN ARBOR MI
48109-2003
US

IV. Provider business mailing address

9400 NEWBURGH RD
LIVONIA MI
48150-3429
US

V. Phone/Fax

Practice location:
  • Phone: 248-946-6881
  • Fax:
Mailing address:
  • Phone: 248-946-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704389256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: