Healthcare Provider Details

I. General information

NPI: 1497150296
Provider Name (Legal Business Name): LAURIE E. GIBBONS C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6853 SW 18TH ST
BOCA RATON FL
33433-7060
US

IV. Provider business mailing address

6853 SW 18TH ST
BOCA RATON FL
33433-7060
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-3775
  • Fax: 561-368-1143
Mailing address:
  • Phone: 561-368-3775
  • Fax: 561-368-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP1805962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: