=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447914148
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE SIMONE GILLINGS APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2021
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 FRONTAGE RD UNIT G
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-2431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-588-4775
-----------------------------------------------------
Fax | 863-422-7664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 878
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33836-0878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-223-3898
-----------------------------------------------------
Fax | 689-223-3898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11015165
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------