Provider Demographics
NPI:1376244392
Name:GILBERT, PEBBLES
Entity type:Individual
Prefix:
First Name:PEBBLES
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 SADLER RD STE 1063
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4434
Mailing Address - Country:US
Mailing Address - Phone:678-622-4712
Mailing Address - Fax:
Practice Address - Street 1:57 S FLETCHER AVE APT A2
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-2265
Practice Address - Country:US
Practice Address - Phone:678-622-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty