Healthcare Provider Details

I. General information

NPI: 1457967614
Provider Name (Legal Business Name): GABRIELLE SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 11/03/2023
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W CENTRAL AVE STE 101
TOLEDO OH
43606-3819
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3900
  • Fax: 419-479-6055
Mailing address:
  • Phone: 419-291-3900
  • Fax: 419-479-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0028526
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704258034
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028526
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: