MEDICARE: N GIBSON PSYCH NP

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	163WP0808X	Psychiatric/Mental Health Registered Nurse

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	OV598	OTHER	FL	GROUP MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12023480	OTHER	FL	CAQH
2	OV604	OTHER	FL	INDIVIDUAL PTAN NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831853340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	N GIBSON PSYCH NP

Provider Business Mailing Address
First Line	:	1016 THOMAS DR # 332
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32408-7444
Country	:	US
Telephone Number	:	850-818-2698
Fax Number	:	949-437-3422

Provider Business Practice Location Address
First Line	:	312 THOMAS DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32408-4902
Country	:	US
Telephone Number	:	850-818-2698
Fax Number	:

Authorized Official
Title or Position	:	OWNER/NP
Name	:	MS. NANCY L. GIBSON
Credential	:	APRN
Telephone Number	:	850-818-2698

Provider Enumeration Date	:	10/30/2021
Last Update Date	:	04/27/2022

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Directions to “N GIBSON PSYCH NP ” Practice Location

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