MEDICARE: MR. COLETTE GIBBS R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	1534422	FL
2	163WC0200X	Critical Care Medicine Registered Nurse	1534422	FL
3	163WC0400X	Case Management Registered Nurse	1534422	FL
4	163WE0003X	Emergency Registered Nurse	1534422	FL
5	163WP0808X	Psychiatric/Mental Health Registered Nurse	1534422	FL

General Provider Information

NPI Number	:	1427251206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COLETTE GIBBS R.N.

Provider Business Mailing Address
First Line	:	7701 SW 136TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-3210
Country	:	US
Telephone Number	:	305-388-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	18055 SW 12TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33194-2715
Country	:	US
Telephone Number	:	305-222-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	09/11/2025

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