Provider Demographics
NPI:1285623926
Name:JERVIS, GABRIELLE ANNE (MS, GCG)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANNE
Last Name:JERVIS
Suffix:
Gender:F
Credentials:MS, GCG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 5TH ST S
Mailing Address - Street 2:DEPT. 7020
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-8599
Mailing Address - Fax:727-767-8367
Practice Address - Street 1:601 5TH ST S
Practice Address - Street 2:DEPT. 7020
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-8559
Practice Address - Fax:727-767-8367
Is Sole Proprietor?:No
Enumeration Date:2005-10-16
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS