Provider Demographics
NPI:1982695052
Name:GIBSON, NANCY L (APRN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:850-625-8515
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2681032163WP0808X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9053AOtherMEDICARE PTAN
FLY9053AOtherMEDICARE PTAN
FLY9053COtherMEDICARE PTAN
FLY9053EOtherMEDICARE PTAN
FLY9053BOtherMEDICARE PTAN
FLY9053DOtherMEDICARE PTAN