Provider Demographics
NPI:1265458285
Name:GIBBONS, PATRICIA D (ANP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:D
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DRIVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 WEST 14TH STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1013
Practice Address - Country:US
Practice Address - Phone:302-733-5625
Practice Address - Fax:302-478-7002
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELB0000174207LP2900X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE018103Medicare ID - Type Unspecified
Q53245Medicare UPIN