Healthcare Provider Details

I. General information

NPI: 1205744778
Provider Name (Legal Business Name): NNEKA GIBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6586 UNIVERSITY BLVD STE 8
WINTER PARK FL
32792-7495
US

IV. Provider business mailing address

6586 UNIVERSITY BLVD STE 8
WINTER PARK FL
32792-7495
US

V. Phone/Fax

Practice location:
  • Phone: 407-304-7340
  • Fax:
Mailing address:
  • Phone: 407-304-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA78033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: