Provider Demographics
NPI:1497150296
Name:GIBBONS, LAURIE E (CNM)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:E
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6853 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7060
Mailing Address - Country:US
Mailing Address - Phone:561-368-3775
Mailing Address - Fax:561-368-1143
Practice Address - Street 1:6853 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7060
Practice Address - Country:US
Practice Address - Phone:561-368-3775
Practice Address - Fax:561-368-1143
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1805962367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife