Provider Demographics
NPI:1265210181
Name:GIBSON, JOSHUA (APRN-CNS)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:JEB
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-CNS
Mailing Address - Street 1:400 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4506
Mailing Address - Country:US
Mailing Address - Phone:240-566-3520
Mailing Address - Fax:
Practice Address - Street 1:400 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4506
Practice Address - Country:US
Practice Address - Phone:240-566-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187114163WE0003X
MDCS00179364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
No163WE0003XNursing Service ProvidersRegistered NurseEmergency