Individual
KENNETH GAMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9298210
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9298210
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BCBS
FL
05
—
PENDING
—
FL
Enumeration date
02/01/2014
Last updated
05/11/2023
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