Healthcare Provider Details

I. General information

NPI: 1992678676
Provider Name (Legal Business Name): GABRIELLE LASANTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2025
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAUREL SPRINGS DR APT 1003
DURHAM NC
27713-6729
US

IV. Provider business mailing address

1000 LAUREL SPRINGS DR APT 1003
DURHAM NC
27713-6729
US

V. Phone/Fax

Practice location:
  • Phone: 850-459-2242
  • Fax:
Mailing address:
  • Phone: 850-459-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number311375
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: