Provider Demographics
NPI:1194137679
Name:FAUSTIN-GABRIEL, JUDITH (DRPH)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:FAUSTIN-GABRIEL
Suffix:
Gender:F
Credentials:DRPH
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:FAUSTIN-GABRIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1800 PEMBROOK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6378
Mailing Address - Country:US
Mailing Address - Phone:321-200-4489
Mailing Address - Fax:407-554-5860
Practice Address - Street 1:1800 PEMBROOK DR STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6378
Practice Address - Country:US
Practice Address - Phone:321-200-4489
Practice Address - Fax:407-554-5860
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9403240363LP2300X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194137679OtherBLUE CROSS BLUE SHIELD
FL1194137679Medicaid