Provider Demographics
NPI:1699169276
Name:GIBBS, TESSA (RN, FNP-C)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:LOVOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 117475
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-7475
Mailing Address - Country:US
Mailing Address - Phone:210-495-7246
Mailing Address - Fax:210-495-7245
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:BUILDING 1 SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5388
Practice Address - Country:US
Practice Address - Phone:210-495-7246
Practice Address - Fax:210-495-7245
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127150363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343924201Medicaid
TX399398YL5EMedicare PIN