Healthcare Provider Details

I. General information

NPI: 1366877441
Provider Name (Legal Business Name): MERCEDES JACQUELINE GIBBONS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W OAK ST
KISSIMMEE FL
34741-4421
US

IV. Provider business mailing address

321 W OAK ST
KISSIMMEE FL
34741-4421
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-1781
  • Fax:
Mailing address:
  • Phone: 833-769-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11001149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: