Healthcare Provider Details

I. General information

NPI: 1982302840
Provider Name (Legal Business Name): MRS. ASHLEY NICOLE GIBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 N COCOA BLVD
COCOA FL
32927-6006
US

IV. Provider business mailing address

8690 CATON AVE
MELBOURNE FL
32904-4804
US

V. Phone/Fax

Practice location:
  • Phone: 321-349-0343
  • Fax:
Mailing address:
  • Phone: 850-445-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: