Provider Demographics
NPI:1760051742
Name:GIBSON, LEAH MELISA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MELISA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MELISA
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 SW 13TH ST APT J190
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3054
Mailing Address - Country:US
Mailing Address - Phone:919-608-2427
Mailing Address - Fax:
Practice Address - Street 1:15652 NW US HIGHWAY 441 STE 2D
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5330
Practice Address - Country:US
Practice Address - Phone:386-418-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95166838163WG0000X
NCRN204838363L00000X
FL110221363363L00000X
FLAPRN110221363363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner