Individual
GABRIELLE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3601 W COMMERCIAL BLVD, STE 4/5, FORT LAUDERDALE, FL 33309-3300
(954) 485-5666
Mailing address
3601 W COMMERCIAL BLVD, STE 4/5, FORT LAUDERDALE, FL 33309-3300
(954) 485-5666
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9287991
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017754300
—
FL
Enumeration date
06/14/2016
Last updated
10/24/2016
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