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General NPI Number Information
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NPI Number | 1376259564
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Entity Type | Individual
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Provider Name | ATIA GIPSON
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Gender | Female
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 1081 TOWN CENTER DR STE 200
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City | ORANGE CITY
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State | FL
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Zip | 32763-8360
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Country | US
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Telephone | 386-218-0764
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Fax | 386-457-4282
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Provider Business Mailing Address
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Address Line | 1081 TOWN CENTER DR STE 200
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City | ORANGE CITY
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State | FL
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Zip | 32763-8360
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Country | US
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Telephone | 386-218-0764
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Fax | 386-457-4282
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11023099
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License Number State | FL
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