Provider Demographics
NPI:1568021319
Name:DEMILT, GINA N (PA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:N
Last Name:DEMILT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:261 BELVOIR HWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8193
Mailing Address - Country:US
Mailing Address - Phone:252-747-8162
Mailing Address - Fax:252-747-8163
Practice Address - Street 1:261 BELVOIR HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8193
Practice Address - Country:US
Practice Address - Phone:252-747-8162
Practice Address - Fax:252-747-8163
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-14648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant