Provider Demographics
NPI:1578228805
Name:GIBBS, JAZZMA JACQUILINE
Entity Type:Individual
Prefix:
First Name:JAZZMA
Middle Name:JACQUILINE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9186 PINEHURST ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-2656
Mailing Address - Country:US
Mailing Address - Phone:313-978-6624
Mailing Address - Fax:
Practice Address - Street 1:9186 PINEHURST ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48204-2656
Practice Address - Country:US
Practice Address - Phone:313-978-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health