MEDICARE: DINA MARIE GIBSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP11376	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063998912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA MARIE GIBSON FNP

Provider Business Mailing Address
First Line	:	3260 N HAYDEN RD STE 112
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-6650
Country	:	US
Telephone Number	:	602-264-9100
Fax Number	:	602-264-9101

Provider Business Practice Location Address
First Line	:	13640 N 99TH AVE
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2866
Country	:	US
Telephone Number	:	623-972-2116
Fax Number	:	623-972-0521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	06/10/2025

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