Healthcare Provider Details

I. General information

NPI: 1609798586
Provider Name (Legal Business Name): LORI GIBBONS PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 29TH CT SW
VERO BEACH FL
32968-3294
US

IV. Provider business mailing address

465 29TH CT SW
VERO BEACH FL
32968-3294
US

V. Phone/Fax

Practice location:
  • Phone: 772-532-3362
  • Fax:
Mailing address:
  • Phone: 772-532-3362
  • Fax: 800-547-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LORI GIBBONS
Title or Position: APRN-C
Credential: APRN
Phone: 772-532-3362