Healthcare Provider Details

I. General information

NPI: 1760143044
Provider Name (Legal Business Name): AUSTIN GIBBS DNP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4207
US

IV. Provider business mailing address

9727 TOUCHTON RD APT 1317
JACKSONVILLE FL
32246-8248
US

V. Phone/Fax

Practice location:
  • Phone: 904-702-6111
  • Fax:
Mailing address:
  • Phone: 404-644-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11017337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: