Provider Demographics
NPI:1528741212
Name:FARRAR, GABRIELLE LYNN (NP)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:LYNN
Last Name:FARRAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:L
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7202 GLEN FOREST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3780
Mailing Address - Country:US
Mailing Address - Phone:804-391-4171
Mailing Address - Fax:804-200-6229
Practice Address - Street 1:263 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-0002
Practice Address - Country:US
Practice Address - Phone:804-431-1100
Practice Address - Fax:804-862-1094
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188027363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner