MEDICARE: MRS. LINDA MARIE GIBSON-YOUNG CRNP

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	163WP0200X	Pediatric Registered Nurse	5835776	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5835776	OTHER	AL	NSG LICENSE

General Provider Information

NPI Number	:	1578538062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA MARIE GIBSON-YOUNG CRNP

Provider Business Mailing Address
First Line	:	31337 PRESTWICK AVE
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-9023
Country	:	US
Telephone Number	:	205-515-6491
Fax Number	:

Provider Business Practice Location Address
First Line	:	31337 PRESTWICK AVE
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-9023
Country	:	US
Telephone Number	:	205-515-6491
Fax Number	:

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	11/13/2009

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