MEDICARE: DANA GABRIELLE PENFOLD

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RC0000X	Cardiovascular Disease Physician	111555	GA
3	207R00000X	Internal Medicine Physician	111555	GA

General Provider Information

NPI Number	:	1265052021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA GABRIELLE PENFOLD

Provider Business Mailing Address
First Line	:	703 N FLAMINGO RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-1006
Country	:	US
Telephone Number	:	786-925-5741
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 WOODRUFF CIRCLE
Second Line	:	WMB SUITE 1105
City	:	ATLANTA
State	:	GA
Zip	:	30322-0001
Country	:	US
Telephone Number	:	404-727-3585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2020
Last Update Date	:	06/01/2026

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Directions to “ DANA GABRIELLE PENFOLD ” Practice Location

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