Healthcare Provider Details

I. General information

NPI: 1699814137
Provider Name (Legal Business Name): GINA CARMEN-FELIZ MASTERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INNOVATION DR STE 400
GREENVILLE SC
29607-5270
US

IV. Provider business mailing address

402 PARK RIDGE CIR
GREER SC
29651-6951
US

V. Phone/Fax

Practice location:
  • Phone: 864-235-7665
  • Fax:
Mailing address:
  • Phone: 864-201-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number24368
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number24368
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: