Provider Demographics
NPI:1891997177
Name:NUCCIO, GINA (DPM)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:NUCCIO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:NUCCIO
Other - Last Name:TITTERINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1001 E WILSON ST
Mailing Address - Street 2:STE 160
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3167
Mailing Address - Country:US
Mailing Address - Phone:630-406-1217
Mailing Address - Fax:630-406-6784
Practice Address - Street 1:1001 E WILSON ST
Practice Address - Street 2:STE 180
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-3168
Practice Address - Country:US
Practice Address - Phone:630-406-1217
Practice Address - Fax:630-406-6784
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004543213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532092OtherBCBS
IL480034904OtherRAILROAD MEDICARE
IL3176990OtherCIGNA
IL203810Medicare ID - Type Unspecified
IL3176990OtherCIGNA
IL480034904OtherRAILROAD MEDICARE