Provider Demographics
NPI:1235684929
Name:GIBBS, FARRAH (RN)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1603
Mailing Address - Country:US
Mailing Address - Phone:516-232-3409
Mailing Address - Fax:
Practice Address - Street 1:3474 113TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11368-1455
Practice Address - Country:US
Practice Address - Phone:718-429-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY591901163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool