Provider Demographics
NPI:1871375493
Name:FLANNERY, GABRIELLE NICOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:NICOLE
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:GABRIELLE
Other - Middle Name:NICOLE
Other - Last Name:GIAMARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3024
Mailing Address - Country:US
Mailing Address - Phone:516-476-6908
Mailing Address - Fax:
Practice Address - Street 1:6 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3024
Practice Address - Country:US
Practice Address - Phone:516-476-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311591363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health