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NPI Code Detail

MEDICARE: BENJAMIN R GIBSON PMHNP LLC

MEDICARE: BENJAMIN R GIBSON PMHNP LLC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1497602056
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENJAMIN R GIBSON PMHNP LLC
Provider Business Mailing Address
First Line : 695 TENNYSON PL
Second Line :
City : PENSACOLA
State : FL
Zip : 32503-3233
Country : US
Telephone Number : 850-485-0994
Fax Number :
Provider Business Practice Location Address
First Line : 1221 E DE SOTO ST
Second Line :
City : PENSACOLA
State : FL
Zip : 32501-3337
Country : US
Telephone Number : 850-437-9997
Fax Number : 850-439-2122
Authorized Official
Title or Position : OWNER
Name : BENJAMIN GIBSON
Credential : PMHNP
Telephone Number : 850-485-0994
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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