Healthcare Provider Details

I. General information

NPI: 1669836904
Provider Name (Legal Business Name): ELIZABETH GMINSKI DNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 07/13/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 JABARA AVE
SEYMOUR JOHNSON A F B NC
27531-2310
US

IV. Provider business mailing address

520 WHISNER ST
GOLDSBORO NC
27534-5487
US

V. Phone/Fax

Practice location:
  • Phone: 919-722-1802
  • Fax: 919-722-4665
Mailing address:
  • Phone: 605-359-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number836129
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: