Provider Demographics
NPI:1386633014
Name:GIBBONS, MICHELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MILITARY TRL
Mailing Address - Street 2:STE 10
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3015
Mailing Address - Country:US
Mailing Address - Phone:954-426-9600
Mailing Address - Fax:
Practice Address - Street 1:100 S MILITARY TRL
Practice Address - Street 2:STE 10
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3015
Practice Address - Country:US
Practice Address - Phone:954-426-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1863652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q05685Medicare UPIN