MEDICARE: SARAH GIBSON NP

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	363LF0000X	Family Nurse Practitioner	4066	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578571733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH GIBSON NP

Provider Business Mailing Address
First Line	:	3027 N CIRCLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1179
Country	:	US
Telephone Number	:	719-776-4646
Fax Number	:	719-776-4640

Provider Business Practice Location Address
First Line	:	225 S UNION BLVD STE 2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3186
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	01/10/2017

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