Provider Demographics
NPI:1730580242
Name:GIBBONS, NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5420 WEBB RD
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3250
Mailing Address - Country:US
Mailing Address - Phone:813-886-0548
Mailing Address - Fax:813-886-0890
Practice Address - Street 1:5420 WEBB RD
Practice Address - Street 2:SUITE B-1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3250
Practice Address - Country:US
Practice Address - Phone:813-886-0548
Practice Address - Fax:813-886-0890
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2025-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9107929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant