Healthcare Provider Details

I. General information

NPI: 1902522402
Provider Name (Legal Business Name): DANIEL S GIBBONS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MILES ST
DAMARISCOTTA ME
04543-4047
US

IV. Provider business mailing address

35 MILES ST
DAMARISCOTTA ME
04543-4047
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-4521
  • Fax: 207-810-4989
Mailing address:
  • Phone: 207-563-4521
  • Fax: 207-810-4989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP221556
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: