MEDICARE: MS. ARIA RAE GIBBONS PA

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	363A00000X	Physician Assistant	014260	NY
2	363A00000X	Physician Assistant	PA1393	ME
3	363AM0700X	Medical Physician Assistant	PA9120053	FL

General Provider Information

NPI Number	:	1902114408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ARIA RAE GIBBONS PA

Provider Business Mailing Address
First Line	:	7751 BELFORT PKWY STE 350
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6951
Country	:	US
Telephone Number	:	904-363-7453
Fax Number	:

Provider Business Practice Location Address
First Line	:	2370 MARKET DR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4326
Country	:	US
Telephone Number	:	904-264-2601
Fax Number	:	904-264-6858

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

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/22/2025

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