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NPI Code Detail

MEDICARE: JENNIFER GAMBLE PA-C

MEDICARE: JENNIFER GAMBLE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantC5-0011583DE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C5-0011583OTHERDESTATE PROFESSIONAL LICENSE
2DA-0024779OTHERDESTATE CONTROLLED SUBSTANCE LICENSE

General Provider Information

NPI Number : 1144991480
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GAMBLE PA-C
Provider Business Mailing Address
First Line : 3411 SILVERSIDE RD STE 100
Second Line :
City : WILMINGTON
State : DE
Zip : 19810-4811
Country : US
Telephone Number : 302-543-5454
Fax Number : 302-327-4200
Provider Business Practice Location Address
First Line : 3411 SILVERSIDE RD STE 100
Second Line :
City : WILMINGTON
State : DE
Zip : 19810-4811
Country : US
Telephone Number : 302-543-5454
Fax Number : 302-327-4200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2021
Last Update Date : 04/22/2024

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Directions to “ JENNIFER GAMBLE PA-C” Practice Location

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