Healthcare Provider Details

I. General information

NPI: 1154007565
Provider Name (Legal Business Name): KRYSTEN GIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7746 BLUE SPRING DR
LAND O LAKES FL
34637-7490
US

IV. Provider business mailing address

7746 BLUE SPRING DR
LAND O LAKES FL
34637-7490
US

V. Phone/Fax

Practice location:
  • Phone: 656-210-6639
  • Fax:
Mailing address:
  • Phone: 656-210-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11025687
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022152218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: