Healthcare Provider Details

I. General information

NPI: 1306322300
Provider Name (Legal Business Name): NICOLE GORECKI DNP, APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2017
US

IV. Provider business mailing address

2710 SWISS AVE
DALLAS TX
75204-5900
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209018007
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP145170
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: