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General NPI Number Information
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NPI Number | 1669930921
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Entity Type | Individual
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Provider Name | MS. JEANETTE MARIA GABAY
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Gender | Female
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 1832 COUNTRY CLUB DR
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City | TITUSVILLE
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State | FL
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Zip | 32780-5346
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Country | US
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Telephone | 407-709-8606
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Fax |
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Provider Business Mailing Address
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Address Line | 1969 S ALAFAYA TRL # 206
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City | ORLANDO
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State | FL
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Zip | 32828-8732
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Country | US
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Telephone | 407-709-8606
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Fax |
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 10800
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License Number State | FL
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