Healthcare Provider Details

I. General information

NPI: 1134876105
Provider Name (Legal Business Name): REFINE DIRECT PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 SUN GLAZE AVE
HENDERSON NV
89011-1578
US

IV. Provider business mailing address

138 SUN GLAZE AVE
HENDERSON NV
89011-1578
US

V. Phone/Fax

Practice location:
  • Phone: 702-728-2214
  • Fax: 702-995-9211
Mailing address:
  • Phone: 702-728-2214
  • Fax: 702-995-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GINA COCCIMIGLIO
Title or Position: OWNER/DNP
Credential:
Phone: 702-728-2214