Healthcare Provider Details

I. General information

NPI: 1659751451
Provider Name (Legal Business Name): GINA COCCIMIGLIO DNP, AGPCNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 S GREEN VALLEY PKWY STE 300
HENDERSON NV
89012-3145
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:
Mailing address:
  • Phone: 702-728-2214
  • Fax: 702-995-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number883917
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: