Provider Demographics
NPI:1184295446
Name:GIBBONS, PETER MCHENRY (CRNA)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MCHENRY
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 ELM HILL PIKE STE 350
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3176
Mailing Address - Country:US
Mailing Address - Phone:844-788-0088
Mailing Address - Fax:
Practice Address - Street 1:5006 MARCHANT DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5111
Practice Address - Country:US
Practice Address - Phone:703-944-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29681367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered