Healthcare Provider Details

I. General information

NPI: 1043020464
Provider Name (Legal Business Name): GABRIELLE SMITH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 KITE DR UNIT 5208
BLUFFTON SC
29910-9435
US

IV. Provider business mailing address

228 KITE DR UNIT 5208
BLUFFTON SC
29910-9435
US

V. Phone/Fax

Practice location:
  • Phone: 478-484-5301
  • Fax:
Mailing address:
  • Phone: 478-484-5301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN297290
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: