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General NPI Number Information
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NPI Number | 1760051742
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Entity Type | Individual
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Provider Name | LEAH MELISA GIBSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 15652 NW US HIGHWAY 441 STE 2D
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City | ALACHUA
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State | FL
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Zip | 32615-5330
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Country | US
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Telephone | 386-418-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 SW 13TH ST APT J190
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City | GAINESVILLE
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State | FL
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Zip | 32608-3054
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Country | US
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Telephone | 919-608-2427
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Fax |
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN95166838
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN204838
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 110221363
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN110221363
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN110221363
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License Number State | FL
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