Provider Demographics
NPI:1730344458
Name:GIBSON, DONNA J (MSNED, RN, FNP-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MSNED, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9160 FORUM CORPORATE PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7808
Mailing Address - Country:US
Mailing Address - Phone:239-785-3200
Mailing Address - Fax:813-630-6105
Practice Address - Street 1:551 BREVARD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2316
Practice Address - Country:US
Practice Address - Phone:828-212-7021
Practice Address - Fax:828-232-8218
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004028363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004285Medicaid
NCP00784829OtherRR MEDICARE
NCNC5143CMedicare PIN
NCP00784829OtherRR MEDICARE
NC2593418AMedicare PIN
NC7004285Medicaid