Provider Demographics
NPI:1154577732
Name:GABRIEL-JACQUES, CHARLYNE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLYNE
Middle Name:
Last Name:GABRIEL-JACQUES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:CHARLYNE
Other - Middle Name:
Other - Last Name:GABRIEL-JACQUES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:200 OCEANGATE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 OCEANGATE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4317
Practice Address - Country:US
Practice Address - Phone:305-382-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9213937363LP2300X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000342500Medicaid
BB217ZMedicare PIN