Individual
GWEN GAMBOA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5456 LUELLA ST, JACKSONVILLE, FL 32207-5920
(904) 866-2937
Mailing address
5456 LUELLA ST, JACKSONVILLE, FL 32207-5920
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9255006
FL
Other
Enumeration date
08/19/2014
Last updated
08/19/2014
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