Provider Demographics
NPI:1952184780
Name:GIBSON, BROOKE ANN (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84-965 FARRINGTON HWY APT 404
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2035
Mailing Address - Country:US
Mailing Address - Phone:503-351-0031
Mailing Address - Fax:
Practice Address - Street 1:3110 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5411
Practice Address - Country:US
Practice Address - Phone:808-697-3517
Practice Address - Fax:808-697-3155
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-4188-0363LF0000X
CA95031357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily