Provider Demographics
NPI:1093704348
Name:GIPPS, VERONICA SILVIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:SILVIA
Last Name:GIPPS
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 1:1211 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1807
Mailing Address - Country:US
Mailing Address - Phone:954-522-8688
Mailing Address - Fax:954-522-8606
Practice Address - Street 1:1211 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1807
Practice Address - Country:US
Practice Address - Phone:954-522-8688
Practice Address - Fax:954-522-8606
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61546208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373625300Medicaid
FL373625300Medicaid
FL15193Medicare ID - Type Unspecified