Individual provider Active NPI

Nikki Prange Grzybowski, APRN

  • Critical Care Pediatric Nurse Practitioner
  • Gainesville, FL
National Provider Identifier
1295187870
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Pediatric Nurse PractitionerTaxonomy code 363LP0222X
License
AP131754 Issued in TX
Practice address
1600 SW Archer Rd
Gainesville, FL 32610-7701
Phone
(352) 265-0111
NPI assigned
Jul 7, 2016
Last updated
Jan 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN11036991 FL
Critical Care Pediatric Nurse Practitioner 363LP0222X AP131754 TX Primary

Addresses

Primary practice location

1600 SW Archer Rd
Gainesville, FL 32610-7701

Mailing address

PO Box 100296
Gainesville, FL 32610-0296
Phone (352) 627-9350

Other practice location 1

1935 Medical District Dr
Dallas, TX 75235-7701
Phone (352) 317-3890

Other names 1

  • Nikki Lauren Gillis Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20250304000453 FL Practitioner - Nurse Practitioner 1153731773 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN11036991FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Jan 23, 2025 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jan 23, 2025 Accepting new patients

Locations

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

Interoperability endpoints

  • Direct secure messaging: nprange14579@direct.shands.ufl.edu

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1295187870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100296",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100296",
            "telephone_number": "352-627-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326107701",
            "telephone_number": "352-265-0111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1935 Medical District Dr",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752357701",
            "country_code": "US",
            "telephone_number": "352-317-3890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRZYBOWSKI",
        "first_name": "NIKKI",
        "middle_name": "PRANGE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-07",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "APRN11036991",
            "primary": false
        },
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "TX",
            "license": "AP131754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIKKI",
            "last_name": "GILLIS",
            "middle_name": "LAUREN",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Gainesville, FL

Sources for this page

Verify at the official NPI Registry.