Provider Demographics
NPI:1831853340
Name:N GIBSON PSYCH NP
Entity type:Organization
Organization Name:N GIBSON PSYCH NP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-818-2698
Mailing Address - Street 1:1016 THOMAS DR # 332
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7444
Mailing Address - Country:US
Mailing Address - Phone:850-818-2698
Mailing Address - Fax:949-437-3422
Practice Address - Street 1:312 THOMAS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32408-4902
Practice Address - Country:US
Practice Address - Phone:850-818-2698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-30
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12023480OtherCAQH
FLOV604OtherINDIVIDUAL PTAN NUMBER
FLOV598OtherGROUP MEDICARE NUMBER
FL768938100Medicaid