Provider Demographics
NPI:1255217394
Name:IDOL, GINA MILLER (NP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MILLER
Last Name:IDOL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 INDIAN WELLS CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-8674
Mailing Address - Country:US
Mailing Address - Phone:336-247-1636
Mailing Address - Fax:
Practice Address - Street 1:600 INDIAN WELLS CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-8674
Practice Address - Country:US
Practice Address - Phone:336-247-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCIDOL-ODMOR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty