MEDICARE: VALENCIA GIBSON

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	106S00000X	Behavior Technician
2	106S00000X	Behavior Technician	RBT-18-67113	FL

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	:	1386135176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALENCIA GIBSON

Provider Business Mailing Address
First Line	:	8950 DOCTOR MARTIN LUTHER KING JR STREET NORTH
Second Line	:	190
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1490 NE PINE ISLAND RD STE 7E-F
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2135
Country	:	US
Telephone Number	:	239-599-8733
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	03/09/2022

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Directions to “ VALENCIA GIBSON ” Practice Location

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