Healthcare Provider Details

I. General information

NPI: 1043826688
Provider Name (Legal Business Name): GREGORY WADE PRINCE ARNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 S VOLUSIA AVE STE B3
ORANGE CITY FL
32763-7625
US

IV. Provider business mailing address

2425 S VOLUSIA AVE STE B3
ORANGE CITY FL
32763-7625
US

V. Phone/Fax

Practice location:
  • Phone: 386-473-7005
  • Fax: 888-355-7970
Mailing address:
  • Phone: 386-473-7005
  • Fax: 888-355-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberARNP11009727
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11009727
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: