MEDICARE: ELLIE RACHEL GIBBERMAN ACNP-BC

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	363L00000X	Nurse Practitioner	4052774	KY
2	363L00000X	Nurse Practitioner	3-002769	AL
3	363LA2100X	Acute Care Nurse Practitioner	0024169086	VA
4	363L00000X	Nurse Practitioner	APRN11044056	FL
5	363L00000X	Nurse Practitioner	C-APN.0105713-C-NP	CO

General Provider Information

NPI Number	:	1295024867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIE RACHEL GIBBERMAN ACNP-BC

Provider Business Mailing Address
First Line	:	46 LITTLE FALLS LN
Second Line	:
City	:	ROCKVILLE
State	:	VA
Zip	:	23146-2123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000A GLENSIDE DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-4102
Country	:	US
Telephone Number	:	804-262-4763
Fax Number	:	804-362-3612

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	05/21/2026

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