Provider Demographics
NPI:1932502259
Name:GIBSON, ARKESHA
Entity Type:Individual
Prefix:
First Name:ARKESHA
Middle Name:
Last Name:GIBSON
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 1:280 S RONALD REAGAN BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5468
Mailing Address - Country:US
Mailing Address - Phone:407-260-0020
Mailing Address - Fax:
Practice Address - Street 1:280 S RONALD REAGAN BLVD STE 115
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5468
Practice Address - Country:US
Practice Address - Phone:407-260-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 11051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist