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General NPI Number Information
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NPI Number | 1285081869
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Entity Type | Organization
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Legal Business Name | JEANNIE GIBERSON
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 4313 TAHITIAN GARDENS DRIVE K2
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City | HOLIDAY
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State | FL
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Zip | 34691
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Country | US
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Telephone | 352-467-4457
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Fax |
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Provider Business Mailing Address
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Address Line | 4313 TAHITIAN GARDENS DRIVE K2 K2
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City | HOLIDAY
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State | FL
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Zip | 34691
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Country | US
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Telephone | 352-467-4457
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | MRS. JEANNIE JUNIOR GIBERSON
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Credential | LCSW
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Telephone | 352-467-4457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | SW13517
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License Number State | FL
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