Healthcare Provider Details

I. General information

NPI: 1366985277
Provider Name (Legal Business Name): TAMIKO M GIBSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2016
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E KATELLA AVE STE 625
ANAHEIM CA
92806-5995
US

IV. Provider business mailing address

15748 SW 49TH CT
MIRAMAR FL
33027-4936
US

V. Phone/Fax

Practice location:
  • Phone: 800-570-4701
  • Fax:
Mailing address:
  • Phone: 786-348-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95029996
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9332358
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9332358
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: