Provider Demographics
NPI:1437662277
Name:GIBBS, TRICIA L (RN)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:GIBBS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:L
Other - Last Name:GALVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-7858
Mailing Address - Country:US
Mailing Address - Phone:518-283-4600
Mailing Address - Fax:518-283-0362
Practice Address - Street 1:25 EAST AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-7858
Practice Address - Country:US
Practice Address - Phone:518-283-4600
Practice Address - Fax:518-283-0362
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576085-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool