Healthcare Provider Details

I. General information

NPI: 1871936641
Provider Name (Legal Business Name): LETICIA M GIBBS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 SPRING HILL AVE
MOBILE AL
36607-1822
US

IV. Provider business mailing address

2900 SPRING HILL AVE
MOBILE AL
36607-1822
US

V. Phone/Fax

Practice location:
  • Phone: 251-287-8420
  • Fax: 251-287-8477
Mailing address:
  • Phone: 251-284-8420
  • Fax: 251-284-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-100307
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: