Healthcare Provider Details

I. General information

NPI: 1093865032
Provider Name (Legal Business Name): NICOLE GILL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOBART ST
CADILLAC MI
49601-2331
US

IV. Provider business mailing address

1498 PACIFIC AVE STE 400
TACOMA WA
98402-4208
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-6009
  • Fax: 231-876-6830
Mailing address:
  • Phone: 855-768-6363
  • Fax: 253-682-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number049613455
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704303193
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN124898
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: