Healthcare Provider Details

I. General information

NPI: 1629951173
Provider Name (Legal Business Name): JOANNA GISSELL GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MEDICAL PAVILION DR
RAEFORD NC
28376-9111
US

IV. Provider business mailing address

5207 SEQUOIA RD
FAYETTEVILLE NC
28304-3026
US

V. Phone/Fax

Practice location:
  • Phone: 910-904-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number370129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: