Provider Demographics
NPI:1861258279
Name:SPIRES, GREGORY (APRN FNP-C)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:SPIRES
Suffix:
Gender:M
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SWEETGUM CT
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1253
Mailing Address - Country:US
Mailing Address - Phone:850-573-0963
Mailing Address - Fax:
Practice Address - Street 1:401 MCEWEN DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2741
Practice Address - Country:US
Practice Address - Phone:850-400-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031011363LF0000X
FLAPRN11031011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily