Provider Demographics
NPI:1750383352
Name:GIBSON, SHEILA (CNM)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S. ANDREWS AVENUE
Mailing Address - Street 2:SUITE 323 WEST WING
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-355-5110
Mailing Address - Fax:954-355-4919
Practice Address - Street 1:200 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-9026
Practice Address - Country:US
Practice Address - Phone:954-355-5110
Practice Address - Fax:954-355-4919
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1700452367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300374400Medicaid
FLY050EZMedicare PIN
FL300374400Medicaid
FLBK984YMedicare PIN