Healthcare Provider Details

I. General information

NPI: 1912519471
Provider Name (Legal Business Name): NICOLE GREGORIO MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE SIBULO

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8687 W SAHARA AVE STE 100
LAS VEGAS NV
89117-5868
US

IV. Provider business mailing address

8687 W SAHARA AVE STE 100
LAS VEGAS NV
89117-5868
US

V. Phone/Fax

Practice location:
  • Phone: 702-830-9588
  • Fax:
Mailing address:
  • Phone: 702-300-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number832739
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number832739
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: