Provider Demographics
NPI:1073950382
Name:NICOSIA, STEFANIE (APN)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:NICOSIA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 ALEXANDER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6345
Mailing Address - Country:US
Mailing Address - Phone:609-921-7456
Mailing Address - Fax:609-921-2972
Practice Address - Street 1:731 ALEXANDER RD STE 202
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6345
Practice Address - Country:US
Practice Address - Phone:609-921-7456
Practice Address - Fax:609-921-2972
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00436200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00436200OtherAPN LICENSE