Provider Demographics
NPI:1053585158
Name:GRIBBLE, ABBY RUTH
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:RUTH
Last Name:GRIBBLE
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 1:4315 SMUGGLERS WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7309
Mailing Address - Country:US
Mailing Address - Phone:904-573-0359
Mailing Address - Fax:904-573-0359
Practice Address - Street 1:4315 SMUGGLERS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7309
Practice Address - Country:US
Practice Address - Phone:904-573-0359
Practice Address - Fax:904-573-0359
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency