Provider Demographics
NPI:1134717853
Name:GIBSON-BRYANT, CAMETRA L (CNA366895)
Entity type:Individual
Prefix:
First Name:CAMETRA
Middle Name:L
Last Name:GIBSON-BRYANT
Suffix:
Gender:F
Credentials:CNA366895
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-0953
Mailing Address - Country:US
Mailing Address - Phone:850-322-0489
Mailing Address - Fax:
Practice Address - Street 1:7123 HAVANA HWY
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-5327
Practice Address - Country:US
Practice Address - Phone:850-322-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA366895376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide