MEDICARE: GIGI'S NURSE REGISTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30213129	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1215885165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIGI'S NURSE REGISTRY LLC

Provider Business Mailing Address
First Line	:	22074 HERNANDO AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5443
Country	:	US
Telephone Number	:	941-370-4079
Fax Number	:	715-800-3188

Provider Business Practice Location Address
First Line	:	2765 TAMIAMI TRL STE D
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5163
Country	:	US
Telephone Number	:	941-370-4079
Fax Number	:	715-800-3188

Authorized Official
Title or Position	:	OWNER
Name	:	YISELL GONZALEZ VELAZQUEZ
Credential	:
Telephone Number	:	941-699-6849

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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