Provider Demographics
NPI:1346399474
Name:GIBBONS, T ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:T
Middle Name:ANN
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 324
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3412
Mailing Address - Country:US
Mailing Address - Phone:941-922-6262
Mailing Address - Fax:
Practice Address - Street 1:4370 S TAMIAMI TRL
Practice Address - Street 2:SUITE 324
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3412
Practice Address - Country:US
Practice Address - Phone:941-922-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5092103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0600Medicare ID - Type Unspecified