Provider Demographics
NPI:1235935263
Name:DR. BETH GABRIEL PSYCHIATRY LLC
Entity type:Organization
Organization Name:DR. BETH GABRIEL PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:904-907-9055
Mailing Address - Street 1:55 SPRING TIDE WAY
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-4416
Mailing Address - Country:US
Mailing Address - Phone:904-907-9055
Mailing Address - Fax:
Practice Address - Street 1:55 SPRING TIDE WAY
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-4416
Practice Address - Country:US
Practice Address - Phone:904-907-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty