Individual
MICHAEL T GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
421 SE OSCEOLA ST, STE 3, STUART, FL 34994-2505
(772) 286-0338
(772) 287-1139
Mailing address
PO BOX 868, STUART, FL 34995-0868
(772) 286-0338
(772) 287-1139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
146302
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP2948472
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004722-00
—
FL
01
—
146302
NURSING LICENSE #
TN
01
—
AQ780Z
FLORIDA MEDICARE
FL
01
—
G4647
BCBS OF FLORIDA
FL
Enumeration date
03/16/2006
Last updated
07/15/2010
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