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General NPI Number Information
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NPI Number | 1306678255
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Entity Type | Individual
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Provider Name | GABRIEL KWAME MAYERSON DNP
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Gender | Male
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1075 TOWN CENTER DR
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City | ORANGE CITY
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State | FL
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Zip | 32763-8360
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Country | US
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Telephone | 386-917-0333
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Fax | 386-917-0335
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Provider Business Mailing Address
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Address Line | 1075 TOWN CENTER DR
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City | ORANGE CITY
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State | FL
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Zip | 32763-8360
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Country | US
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Telephone | 386-917-0333
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Fax | 386-917-0335
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 11034886
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License Number State | FL
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