Provider Demographics
NPI:1588265268
Name:GIBSON, RACHEL MOORE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MOORE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 S DALE MABRY HWY UNIT 20412
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3677
Mailing Address - Country:US
Mailing Address - Phone:803-201-4779
Mailing Address - Fax:
Practice Address - Street 1:5145 S DALE MABRY HWY UNIT 20412
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3677
Practice Address - Country:US
Practice Address - Phone:803-201-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9524133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86084369OtherCOMMISSION ON DIETETIC REGISTRATION
FLND9524OtherFLORIDA DEPARTMENT OF HEALTH