Provider Demographics
NPI:1144506429
Name:GIBBS, KRISTINE CONSUNJI (FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:CONSUNJI
Last Name:GIBBS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9220 HAVEN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8551
Mailing Address - Country:US
Mailing Address - Phone:909-944-9058
Mailing Address - Fax:909-948-3893
Practice Address - Street 1:9220 HAVEN AVE
Practice Address - Street 2:STE 101
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8551
Practice Address - Country:US
Practice Address - Phone:909-944-9058
Practice Address - Fax:909-948-3893
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP4226363LF0000X
CA20104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily