Healthcare Provider Details

I. General information

NPI: 1528741212
Provider Name (Legal Business Name): GABRIELLE LYNN FARRAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELLE L FIELDS NP

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MEDICAL PARK BLVD
PETERSBURG VA
23805-0002
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-431-1100
  • Fax: 804-862-1094
Mailing address:
  • Phone: 804-391-4171
  • Fax: 804-200-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024188027
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: