Provider Demographics
NPI:1972564755
Name:GIBSON, FLORENCETTA H
Entity type:Individual
Prefix:
First Name:FLORENCETTA
Middle Name:H
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WASHINGTON ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6714
Mailing Address - Country:US
Mailing Address - Phone:318-322-8482
Mailing Address - Fax:318-322-5694
Practice Address - Street 1:300 WASHINGTON ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6714
Practice Address - Country:US
Practice Address - Phone:318-322-8482
Practice Address - Fax:318-322-5694
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN036503 AP01392364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1164101Medicaid
LA1164101Medicaid