=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720671662
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE GEIL NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2021
-----------------------------------------------------
Last Update Date | 07/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2930 2ND AVE STE 200
-----------------------------------------------------
City | MARINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93933-6244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-582-2100
-----------------------------------------------------
Fax | 831-886-1529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 WILSON RD STE 100
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-7885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-649-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 29074
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11015370
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 95029890
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------