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General NPI Number Information
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NPI Number | 1679045330
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Entity Type | Individual
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Provider Name | NICOLE LYNN GRESS CNM
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Gender | Female
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Dates
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Enumeration Date | 12/19/2018
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 301 HEALTH PARK BLVD STE 219
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-5795
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Country | US
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Telephone | 904-819-9898
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Fax | 904-819-9594
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Provider Business Mailing Address
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Address Line | PO BOX 748817
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City | ATLANTA
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State | GA
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Zip | 30374-8817
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Country | US
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Telephone | 813-286-0333
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Fax | 813-282-1806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN11011386
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | R40191
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | APRN11011386
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License Number State | FL
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