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General NPI Number Information
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NPI Number | 1346415577
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Entity Type | Individual
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Provider Name | JANE S GIBSON PHD
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Gender | Female
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 8150 CHANCELLOR DR SUITE 110
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City | ORLANDO
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State | FL
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Zip | 32809-7691
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Country | US
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Telephone | 407-587-4243
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Fax | 407-251-5053
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Provider Business Mailing Address
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Address Line | 7111 FAIRWAY DR SUITE 400
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-4204
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Country | US
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Telephone | 800-330-6565
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Fax | 561-712-7349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0203X
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Taxonomy Name | Clinical Molecular Genetics Physician
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License Number | D130551
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License Number State | FL
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