Provider Demographics
NPI:1174825046
Name:GIBBS, LYNDA (FNP)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 OLD DOMINION DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4504
Mailing Address - Country:US
Mailing Address - Phone:703-288-0794
Mailing Address - Fax:703-288-0796
Practice Address - Street 1:6707 OLD DOMINION DR
Practice Address - Street 2:SUITE 300
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4504
Practice Address - Country:US
Practice Address - Phone:703-288-0794
Practice Address - Fax:703-288-0796
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017137495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily