Provider Demographics
NPI:1558826917
Name:GIBBONS, REBECCA JOY (AP, DOM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOY
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1251
Mailing Address - Country:US
Mailing Address - Phone:828-424-4002
Mailing Address - Fax:
Practice Address - Street 1:214 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1251
Practice Address - Country:US
Practice Address - Phone:727-272-3587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist