Provider Demographics
NPI:1679566640
Name:GIBSON, TAMMY JEAN (CNA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JEAN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17302 BROADLAND LN
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-8545
Mailing Address - Country:US
Mailing Address - Phone:863-467-4606
Mailing Address - Fax:
Practice Address - Street 1:17304 BROADLAND LN
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-8545
Practice Address - Country:US
Practice Address - Phone:863-467-5704
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant