Provider Demographics
NPI:1962793778
Name:HABET, GISELLE KHADINE (MD)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:KHADINE
Last Name:HABET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:904-650-2193
Mailing Address - Fax:904-201-6350
Practice Address - Street 1:155 BARTRAM MARKET DR STE 120
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4582
Practice Address - Country:US
Practice Address - Phone:904-650-2193
Practice Address - Fax:904-201-6350
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119958208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017180200Medicaid