Active NPI
Odessa Odara Gibson, RN
- Registered Nurse
- Hollywood, FL
National Provider Identifier
1467800573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN9353890
- Practice address
- 3501 Johnson St
Hollywood, FL 33021-3302 - Phone
- (954) 265-5808
- NPI assigned
- May 31, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN9353890 | FL | Primary |
Addresses
Primary practice location
3501 Johnson St
Hollywood, FL 33021-3302
Mailing address
19454 NW 29TH CT
Miami Gardens, FL 33056-0600
Phone (786) 444-7655
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN9353890 | FL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602115200000",
"number": "1467800573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19454 NW 29TH CT",
"city": "MIAMI GARDENS",
"state": "FL",
"postal_code": "330560600",
"telephone_number": "786-444-7655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3501 JOHNSON ST",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330213302",
"telephone_number": "954-265-5808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "ODESSA",
"middle_name": "ODARA",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-31",
"last_updated": "2020-10-08",
"certification_date": "2020-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "FL",
"license": "RN9353890",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.