Provider Demographics
NPI:1023271541
Name:GIBSON, THERESE ANNE (NP)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:ANNE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HARBOR DR
Mailing Address - Street 2:NO 7C
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054
Mailing Address - Country:US
Mailing Address - Phone:760-433-7304
Mailing Address - Fax:760-433-2293
Practice Address - Street 1:1200 HARBOR DR N
Practice Address - Street 2:UNIT 7C
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-1064
Practice Address - Country:US
Practice Address - Phone:760-420-2293
Practice Address - Fax:760-433-2293
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily