Individual provider Active NPI

Christine Sicard, NP

  • Nurse Practitioner
  • Gloucester, MA
National Provider Identifier
1174369193
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN2274165 Issued in MA
Practice address
1 Blackburn Dr
Gloucester, MA 01930-2292
Phone
(978) 281-1500
NPI assigned
Jul 9, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN2274165 MA Primary

Addresses

Primary practice location

1 Blackburn Dr
Gloucester, MA 01930-2292

Mailing address

14 Corliss Ave
Gloucester, MA 01930-1608
Phone (978) 290-2679

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240912003783 MA Practitioner - Nurse Practitioner 6800336165 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN2274165MAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cape Ann Medical Center LLC CurrentSince Sep 4, 2024 Accepting new patients

Locations

1 Blackburn Dr
Gloucester, MA 01930
Phone (978) 282-3698

1 Blackburn Dr
Ste 1
Gloucester, MA 01930

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1174369193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 CORLISS AVE",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019301608",
            "telephone_number": "978-290-2679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BLACKBURN DR",
            "city": "GLOUCESTER",
            "state": "MA",
            "postal_code": "019302292",
            "telephone_number": "978-281-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SICARD",
        "first_name": "CHRISTINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-09",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2274165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gloucester, MA

Sources for this page

Verify at the official NPI Registry.