Healthcare Provider Details

I. General information

NPI: 1316727894
Provider Name (Legal Business Name): NICOLE WINKELS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 NESS CIR
ST AUGUSTINE FL
32095-7622
US

IV. Provider business mailing address

327 NESS CIR
ST AUGUSTINE FL
32095-7622
US

V. Phone/Fax

Practice location:
  • Phone: 262-224-3791
  • Fax:
Mailing address:
  • Phone: 262-224-3791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11028492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: