Provider Demographics
NPI:1326524075
Name:GILL, NICOLE MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:GILL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:FRANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5008 N GLEN PARK PLACE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4694
Mailing Address - Country:US
Mailing Address - Phone:309-306-1322
Mailing Address - Fax:309-204-6991
Practice Address - Street 1:5008 N GLEN PARK PLACE RD STE B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4695
Practice Address - Country:US
Practice Address - Phone:309-306-1322
Practice Address - Fax:309-204-6991
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily