Gabrielle Wienckoski, APRN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

APRN11030359 Issued in FL

Practice address

675 S Babcock St Ste 1
Melbourne, FL 32901-1459

Phone

(321) 951-1010

Fax

(321) 951-1010

NPI assigned

Jan 29, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Indigo Dermatology LLCGroup PAC ID 9638469869, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11690/brand/1/csg/1/fhir/r4

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.

• Indigo Dermatology LLC

  • Specialist
  • Melbourne, FL
  • NPI 1659743094
  Medicare reassignment Care Compare group NPD
• Quality Medical Care PA

  • Interventional Cardiology Physician
  • Melbourne, FL
  • NPI 1114912607
  NPD (past)

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

{
    "created_epoch": "1706486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1679335335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 S BABCOCK ST",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011459",
            "telephone_number": "321-951-1010",
            "fax_number": "321-952-4038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 S BABCOCK ST STE 1",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011459",
            "telephone_number": "321-951-1010",
            "fax_number": "321-951-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIENCKOSKI",
        "first_name": "GABRIELLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-29",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "APRN11030359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Mortin Wicker
• Wickham Discount Pharmacy LLC
• Wickham Pediatrics Center PS
• Kristen Jane Wiederhold
• Alexandrea Hope Wiegand, M.S., BCBA
• Adam Howard Wiener, D.O.
• Jason C Wieseler, PSY.D.
• Phylicia Wiggins-Hutchinson
• Ann Susan Wilbee, LCSW
• Melissa Wilborn, LMHC

• Licensed Practical Nurse in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Licensed Practical Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.