Healthcare Provider Details

I. General information

NPI: 1982402418
Provider Name (Legal Business Name): EMMA COLE GAVIDIA DNP, PNPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

6238 GALA LN
CHARLOTTE NC
28215-2275
US

V. Phone/Fax

Practice location:
  • Phone: 904-422-3099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5025573
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License NumberK3JQ84ZW
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: