NPIMap

Individual provider Active NPI

Gloria Lynn Niquette, ARNP

  • Nurse Practitioner
  • Lake Butler, FL
National Provider Identifier
1366874174
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP9214471 Issued in FL
Practice address
155 SE 6TH PL
Lake Butler, FL 32054-2213
Phone
(386) 496-1236
NPI assigned
Aug 2, 2013
Last updated
Jul 17, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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 ARNP9214471 FL Primary

Addresses

Primary practice location

155 SE 6TH PL
Lake Butler, FL 32054-2213

Mailing address

345 W. Madison St
Starke, FL 32091-3923
Phone (904) 964-5455

Other practice location 1

345W Madison St
Starke, FL 32091-3923
Phone (904) 964-5455

Other identifiers 1

IdentifierTypeStateIssuer
LICENCE NUMBEROtherFLARNP9214471

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140805001726 FL Practitioner - Nurse Practitioner 9436376035 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
May accept Medicare assignment
Group practices
Starke Family Medical Center IncGroup PAC ID 0143207704, 13 clinicians
Lake Area Physical Therapy Inc.Group PAC ID 3678604840, 372 clinicians

Practice addresses (Care Compare)

345 W Madison St
Starke, FL 32091-3923
Phone (904) 964-5455

PO Box
Suite 1099
Melrose, FL 32666-1099

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.43 of 100Reported as individual
Quality
94.05
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ARNP9214471FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Starke Family Medical Center Inc CurrentSince Jun 26, 2015 Accepting new patients

Locations

100 S Lawrence Blvd
Keystone Hgts, FL 32656
Phone (352) 473-9373

155 SE 6th Pl
Lake Butler, FL 32054
Phone (386) 438-8391

345 W Madison St
Starke, FL 32091
Phone (904) 964-5455

Interoperability endpoints

  • Direct secure messaging: gloria.niquette.1@16275.direct.athenahealth.com

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.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1375401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1366874174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 W. MADISON ST",
            "city": "STARKE",
            "state": "FL",
            "postal_code": "320913923",
            "telephone_number": "904-964-5455",
            "fax_number": "904-964-4099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 SE 6TH PL",
            "city": "LAKE BUTLER",
            "state": "FL",
            "postal_code": "320542213",
            "telephone_number": "386-496-1236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345W MADISON ST",
            "address_purpose": "LOCATION",
            "city": "STARKE",
            "state": "FL",
            "postal_code": "320913923",
            "country_code": "US",
            "telephone_number": "904-964-5455",
            "fax_number": "904-964-4099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIQUETTE",
        "first_name": "GLORIA",
        "middle_name": "LYNN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-02",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9214471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARNP9214471",
            "identifier": "LICENCE NUMBER",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Butler, FL

Sources for this page

Verify at the official NPI Registry.