Provider Demographics
NPI:1184405995
Name:GIBBS, PHLISIDA L (HHA,CMA)
Entity type:Individual
Prefix:
First Name:PHLISIDA
Middle Name:L
Last Name:GIBBS
Suffix:
Gender:F
Credentials:HHA,CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 SAVANNAH RIVER WAY APT 218
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-5070
Mailing Address - Country:US
Mailing Address - Phone:321-420-3612
Mailing Address - Fax:
Practice Address - Street 1:5004 SAVANNAH RIVER WAY APT 218
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-5070
Practice Address - Country:US
Practice Address - Phone:321-420-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2022208P374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide