Healthcare Provider Details

I. General information

NPI: 1205608650
Provider Name (Legal Business Name): GINA STYLES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14653 US HIGHWAY 17
HAMPSTEAD NC
28443-3505
US

IV. Provider business mailing address

204 EGRET POINT DR
SNEADS FERRY NC
28460-9464
US

V. Phone/Fax

Practice location:
  • Phone: 978-337-9421
  • Fax:
Mailing address:
  • Phone: 978-337-9421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOOK-ISGFQ
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: