=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275296378
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GABRIELE MITTEREGGER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2021
-----------------------------------------------------
Last Update Date | 11/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1490 SE MAGNOLIA EXT
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-4443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-512-9703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12650 SE 120TH ST
-----------------------------------------------------
City | DUNNELLON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34431-8300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-402-4332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 11015988
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------