Healthcare Provider Details

I. General information

NPI: 1295024867
Provider Name (Legal Business Name): ELLIE RACHEL GIBBERMAN ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000A GLENSIDE DR
HENRICO VA
23228-4102
US

IV. Provider business mailing address

46 LITTLE FALLS LN
ROCKVILLE VA
23146-2123
US

V. Phone/Fax

Practice location:
  • Phone: 804-262-4763
  • Fax: 804-362-3612
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4052774
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3-002769
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024169086
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11044056
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberC-APN.0105713-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: